Table 2 - uploaded by Fehmidah Munir
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Final themes from focus group and interview data
Source publication
Evidence suggests that supervisors' behaviors have a strong influence on employees' health and well-being outcomes. Few have examined the specific behaviors associated with managing an employee back to work following long-term sick leave. This study describes the development of a behavior measure for Supervisors to Support Return to Work (SSRW) usi...
Context in source publication
Similar publications
Background:
Burnout is the leading cause of absenteeism in the Netherlands, with associated sick leave costs amounting to around €1.8 billion. Studies have indicated that burnout complaints increased from almost 14.4% in 2014 to 17.3% in 2018, especially among employees between the ages of 18 and 35 years, and further increases are expected. Altho...
Citations
... Qualitatively, individual studies have found that the supervisors' positive, inclusive behaviours during RTW, procedural knowledge (14), early contact with workers off work, clearly communicated policies, modified work, and specialist case manager positions (15) are associated with improved RTW. Nielsen and Yarker (16) interviewed workers who had returned to work following a CMD and found managers could be classified as compassionate, indifferent, or demeaning with only the compassionate managers viewed favourably by workers. Meanwhile, recognition of workers returning to work from leaders and co-workers was theorized to be a foundation for expression of support behaviours and feeling supported. ...
Background
Research demonstrates sustained return to work (RTW) by individuals on medical leave is influenced by personal and job resources and job demands. Relatively few studies have been conducted in the workers’ compensation context that is known to have longer absence durations for RTW.
Aims
This study sought to illuminate workers’ experience as they returned to work following a work injury that was either psychological in nature or involved more than 50 days of disability, with a focus on the co-worker, supervisor, and employer actions that supported their return.
Methods
Workers in Saskatchewan, Canada, with a work-related psychological or musculoskeletal injury, subsequent disability, and who returned to work in the last three years, were invited to complete an online survey comprising of free-text questions. Thematic analysis was used to explore participants’ experiences.
Results
Responses from 93 individuals were analysed. These revealed that persistent pain, emotional distress, and loss of normal abilities were present during and beyond returning to work. Almost two-thirds indicated that the supervisors’ and co-workers’ support was critical to a sustained return to work: their needs were recognized and they received autonomy and support to manage work demands. By contrast, one-third indicated that the support they expected and needed from supervisors and employers was lacking.
Conclusions
Workers returning to work lacked personal resources but co-workers’ and supervisors’ support helped improve confidence in their ability to RTW. Supervisors and employers should acknowledge workers’ experiences and offer support and autonomy. Likewise, workers can expect challenges when returning to work and may benefit from cultivating supportive relationships with co-workers and supervisors.
... Lower education and socio-economic status, older age, lower selfefficacy, poor line manager and/or co-worker support, inadequate work adjustments or lack of freedom to work flexibly (i.e. job crafting) and inadequate workplace return-to-work policies can all hamper sustainable return to work [16][17][18][19]. This has a detrimental impact on workers, leading to early retirement, job termination, unemployment [4] and reduced quality of life [9]. ...
Background
Long-term sickness costs businesses in the United Kingdom (UK) approximately £7 billion per annum. Most long-term sickness absences are attributed to common mental health conditions, which are also highly prevalent in people with acute or musculoskeletal health conditions. This study will pilot the IGLOo (Individual, Group, Leaders, Organisation, overarching context) intervention which aims to support workers in returning to and remaining in work following long-term sickness absence. The potential impact of the intervention is a timely return to work (main trial primary outcome) and prevention of a further episode of long-term sick leave. The intervention will be piloted in a randomised controlled trial (RCT) to examine the feasibility of the intervention (pilot trial primary outcome) and to inform a fully powered definitive trial to evaluate sustainable return to work (RTW) in people with primary or secondary mental ill-health who go on long-term sick leave.
Methods and design
A two-arm feasibility randomised controlled trial (with a 30-month study period including 12-month follow-up) of the IGLOo intervention will be conducted in large organisations (≥ 600 workers) from the Yorkshire and Humberside regions, in the UK. Eight consenting organisations will be recruited and randomised to the intervention or control arms of the study (1:1 ratio), with a minimum recruitment target of 13 workers eligible to participate from each. Organisations assigned to the control group will continue with their usual practice. Feasibility data will include data collected on recruitment, retention and attrition of participants; completion of research outcome measures; and intervention compliance. Measurements of mental health, RTW, work outcomes, quality-of-life, workplace support and communication and other demographic data will be taken at baseline, 3, 6, 9 and 12 months in all participants. Qualitative interviews and survey data with all participants will explore the experiences of participants, acceptability of the intervention components and evaluation measures. Exploratory economic evaluation will be conducted to further inform a definitive trial.
Discussion
The findings from this pilot study will help to inform the development of a definitive cluster RCT designed to examine the efficacy of this intervention on health and work-related outcomes in UK workers on long-term sick leave.
Trial registration
ISRCTN11788559 (prospectively registered, date registered 6 October 2022)
... Although most workers with common MH conditions will RTW, this can be a complicated and long process [14]. Factors beyond the MH problems itself that are known to impact both RTW and ongoing work retention include lower socio-economic status, education and selfefficacy, older age, poor manager/supervisor and/or coworker support, and inadequate workplace RTW policies and work adjustments [15][16][17][18]. ...
... However, RTW can be defined as both a process and an outcome related to when an individual returns to work after sick leave [53]; as RTW interventions can improve feelings of confidence and empowerment in the worker when returning to work [52]. RTW interventions also improve wellbeing and workability after a worker has come back to work, through the mechanism of the manager providing regular communication and support whilst the worker is on sick leave [18,32]. Therefore, informed by our discussions and the review findings, the list of performance objectives and behaviour change matrix were constructed by the research team accounting for the complexity of RTW as a process as well as an outcome (Additional files 2 3, 4 and 5). ...
Background
Managing long-term sickness absence is challenging in countries where employers and managers have the main responsibility to provide return to work support, particularly for workers with poor mental health. Whilst long-term sick leave and return to work frameworks and guidance exist for employers, there are currently no structured return to work protocols for employers or for their workers encompassing best practice strategies to support a positive and timely return to work outcome.
Purpose
To utilise the intervention mapping (IM) protocol as a framework to develop return to work toolkits that are underpinned by relevant behaviour change theory targeting mental health to promote a positive return to work experiensce for workers on long-term sick leave.
Methods
This paper provides a worked example of intervention mapping (IM) to develop an intervention through a six-step process to combine theory and evidence in the development of two toolkits – one designed for managers and one to be used by workers on long-term sick leave. As part of this process, collaborative planning techniques were used to develop the intervention. A planning group was set up, through which researchers would work alongside employer, worker, and mental health professional representatives to develop the toolkits. Additionally, feedback on the toolkits were sought from the target populations of workers and managers and from wider employer stakeholders (e.g., human resource specialists). The implementation and evaluation of the toolkits as a workplace intervention were also planned.
Results
Two toolkits were designed following the six steps of intervention mapping. Feedback from the planning group (n = 5; psychologist, psychiatrist, person with previous experience of poor mental health, employer and charity worker) and participants (n = 14; employers = 3, wellbeing director = 1; human resources = 2, managers = 2, employees with previous experience of poor mental health = 5) target populations indicated that the toolkits were acceptable and much needed.
Conclusions
Using IM allowed the development of an evidence-based practical intervention, whilst incorporating the views of all the impacted stakeholder groups. The feasibility and acceptability of the toolkits and their supporting intervention components, implementation process and methods of assessment will be evaluated in a feasibility pilot randomised controlled trial.
... These work adjustments include taking time off when workers are struggling to avoid them going on sick leave again and taking time away from the workplace by working from home or going for a walk. Previous studies on the return-to-work journey have identified key leadership behaviours to be communication, privacy management and knowledge of company policies (Johnston et al., 2015;Munir et al., 2012); however, in studying leaders' behaviours post-return, we were able to identify which strategies returned workers felt helped them stay and thrive at work in the months after return. Thrivers and survivors in particular have positive experiences with work adjustments being implemented that support their staying and thriving at work, whereas the exiteers, to a greater extent, describe that unhelpful adjustments have been made. ...
The research on return to work for workers with common mental disorders has primarily focused on the pre‐return journey. Relapses and recurrent sick leaves are prevalent and call for research on how we can support workers stay and thrive at work after long‐term sickness absence due to common mental disorders. In the present study, we used Longitudinal Interpretative Phenomenological Analysis to explore the experiences of returned workers' post‐return journey and the barriers and facilitators to staying and thriving at work. We conducted monthly semistructured interviews with seven returned workers over a period of 4 months. We identified three post‐return trajectories: the thrivers, the survivors and the exiteers. We identified 10 higher order themes and 13 subthemes that influenced these trajectories. At the individual level, wanting to make a valuable contribution and job crafting facilitated a sustainable return. At the group level, we identified social support as a facilitator. At the leader level, line managers making work adjustments and recognising workers as valuable were important, whereas a lack of understanding and conflicts with senior management posed as barriers. At the overarching level, the media influenced organisational values. Our findings have important implications for how organisations can facilitate a whole systems approach to support returned workers and prevent sickness absence reoccurrence and job loss.
... There are eleven return-to-work scales which were developed as health specific outcome measures: Return-to-Work Self-Efficacy Questionnaire (RTWSE) by Shaw and Huang [41], Readiness for Return-to-Work (RRTW) by Franche et al. [42] for sick leave, Supervisors to Support Return-to-Work (SSRW) by Munir et al. [43] for measuring behavior of supervisors, Return-to-Work Obstacle and Self Efficacy Scale (ROSES) by Corbiere et al. [44], Psychosocial Aspect of Work Questionnaire (PAWQ) by Gray, Adefolarin and Howe [45] for workers with low back pain, Quality of Work Life Scale by Nanjundeswaraswamy [46], Successful Return-to-Work by Greidanus et al. [47], Obstacles to Return-to-Work Questionnaire (ORTWQ) by Milani [48] for cancer survivors, Work Rehabilitation Questionnaire (WORQ) by Finger et al. [49], Work Role Functioning Questionnaire 2.0. The Work Role Functioning Questionnaire (WRFQ) by Abma, van der Klink and Bultmann [50], The Quality of Working Life Questionnaire by Monnette et al. [51], and the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS). ...
Background:
The Return-to-Work Assessment Scale (RAS) was developed in 2021 by Ibikunle et al. to assess return to work among post stroke survivors.
Objective:
The aim of this study was to describe how the conceptual (flag model and ICF) and theoretical framework (C-OAR-SE) were used in developing the RAS.
Method:
The development of the RAS consisted of three phases: (i) Initial item generation (ii) face and content validity (iii) Psychometric testing. With each phase embracing the flag model, international classification of functioning, disability and health (ICF) and the C-OAR-SE an acronym for the six aspects of the theory: 'C' [construct definition], 'OAR' [object representation, attribute classification, and rater entity identification], and 'SE' [selection of item type and answer scale, as well as, enumeration.
Results:
A triangulated approach drawn on three separate theories and models. Phase one was developed by using the Flag model which provided the semi structured open ended questions that materialized into the draft instrument while phases two and three were developed using the ICF and the C-OAR-SE. The scale consists of two sections, A and B. Section A comprises general information about post-stroke survivors, which would not be scored, while section B includes three parts that are important to consider when deciding to return to work.
Conclusion:
An instrument called RAS was developed, an excellent, internally consistent, as well as reliable tool that has demonstrated good group and structural validity.
... Little physical work 29,36 Longer tenure 29 Less job strain 29 Adapted workplace 29,55 Job redesign 29 Managerial and colleague involvement 36,[55][56][57] Job satisfaction 53,54 Adaptation of working time: return part-time or progressive, 58 working hours adaptation or therapeutic work resumption 29 ...
Objectives:
Chronic pain has a substantial negative impact on work-related outcomes, which underlines the importance of interventions to reduce the burden. Spinal cord stimulation (SCS) efficiently relieves pain in specific chronic pain syndromes and is recommended for treating failed back surgery syndrome (FBSS) or post-surgical chronic back pain that is refractory to other treatments. To examine the impact of SCS in patients with FBSS on the return to work (RTW), we determined the RTW rate and the factors positively associated with the RTW.
Materials and methods:
Among 106 patients with FBSS who benefitted from SCS at a single institution in France between September 1999 and March 2010, we retrospectively included 59 who had stopped work at the time of SCS because of disability or sick leave and evaluated the RTW (rate and predictors, estimating odds ratios [ORs] and 95% confidence intervals [CIs]).
Results:
The mean (SD) post-surgery follow-up for the 59 patients (34 men; mean [SD] age 46.9 [7.4] years) was 7.5 (3.6) years (range 5-15). The RTW rate was 30.5%, with a median [IQR] recovery time of 5.5 months [3-8.5]. RTW was improved with functional improvement evolution (OR 1.1, 95% CI [1.01-1.1], p=0.02) and was reduced with unemployment > 3 years (OR 0.1, 95% CI [0.01-0.7], p=0.02).
Conclusions:
Our protocol for SCS for patients with FBSS, including a strict selection of patients and a multidisciplinary approach, led to good results, especially for the RTW. RTW should be a therapeutic goal, directly affecting indirect costs related to FBSS.
... CMDs are more prevalent and more easily adjustable for in the workplace than more severe illnesses, such as schizophrenia and bipolar disorders (OECD, 2014). Previous research has found that supervisors play an important role in supporting employees with mental health problems return to work as they are the main point of contact during sick leave and play a key role in agreeing work adjustments at the point of reentry to work (Aas et al., 2008;Joosen et al., 2021;Munir et al., 2012). A recent survey revealed that 84% of supervisors are aware of their impact on their employees' mental health (BITC, 2019). ...
... As highlighted above, only few qualitative studies have focused explicitly on supervisors' support for the employee during the sickness absence period. Studies have found that employees and supervisors have reported that effective communication, ability to manage privacy and disclose reasons for sickness absence to colleagues, ability to establish trust, being understanding and approachable, knowledge of organisational policies, and ability to develop work adjustments were important in the sickness absence and reentry phases of RTW (Johnston et al., 2015;Joosen et al., 2021;Munir et al., 2012;Negrini et al., 2018). Furthermore, Aas et al. (2008) identified 78 supervisor qualities and seven supervisor types that supported employees' return, which were classified as protectors, encouragers, problem-solvers, contact-makers, trust creators, recognisers, and responsibility makers (offensive and direct supervisors). ...
... Although supervisors were interviewed 12 months later, there was little focus on the post-return period (Ladegaard et al., 2019). Munir et al. (2012) identified a few negative behaviours which prevented RTW, such as supervisors losing patience with employees, making them feel like a nuisance, engaging in aggressive actions, questioning the behaviours of employees, and going against work adjustments. Importantly, Munir et al. (2012) found supervisors lacked knowledge and skills to determine which work accommodations could be implemented. ...
Supervisors play an important role in supporting employees to return to work following sickness absence due to common mental disorders; stress, anxiety and depression, however, employees may not always feel supported. We examined employees’ perceptions of their supervisors’ attitudes and behaviours pre, during and following sickness absence due to common mental disorders, placing a particular focus on post-return. In a qualitative study, using purposeful sampling, we recruited and interviewed 39 returned employees up to four times. We identified three types of supervisor behaviours: the compassionate, the indifferent and the demeaning. Compassionate supervisors possessed empathy and communication skills, worked collaboratively to identify appropriate work adjustments and provided ongoing support and adjustment. Indifferent supervisors lacked the skills and motivation to support returning employees. They did what was required according to organisational policies. Demeaning supervisors lacked understanding and displayed stigmatising behaviour. The results extend our understanding of how supervisors may support returned employees in two ways: First, our results identified three distinct sets of supervisor behaviours. Second, the results indicate that it is important to understand return to work as lasting years where employees are best supported by supervisors making adjustments that fit the needs of returned employees on an ongoing basis.
... Koopmans et al. (2011) found almost 20% of returned workers with CMDs experienced recurrent sick leave over a seven-year period. Line managers are often allocated responsibility for ensuring that the employer's legal obligations are met (Lemieux et al., 2011), being the main point of contact during sick leave and agreeing work adjustments upon return (Munir et al., 2012). Line managers may also play a key role in supporting the worker readjusting to work in the sustainable phase. ...
... Furthermore, time pressure may hinder line managers' attempts to engage in supportive behaviors in the sustainable phase. Previous studies of RTW have found that line managers reported lacking knowledge and skills to make suitable work adjustments in the re-entry phase, and this lack of confidence may also influence their behaviors in the sustainable phase (Lemieux et al., 2011;Munir et al., 2012). To the best of our knowledge, no studies have explored the factors that influence line managers' behaviors in the sustainable phase; however, Ladegaard et al. (2019) explored the challenges and opportunities line managers experienced supporting the RTW of workers on sick leave due to stress. ...
Purpose
Sustainable return to work remains challenging for workers returning after long-term sick leave due to common mental disorders (CMDs): stress, anxiety and depression. Line managers play a significant role in supporting returned workers. Therefore, the purpose of this qualitative study was to examine the supportive behaviors of line managers in supporting returned workers.
Design/methodology/approach
The authors conducted a longitudinal study with up to three semi-structured interviews with 20 line managers with experience managing returned workers. In these interviews, the authors asked questions about the supportive behaviors line managers enacted to support workers and the role of the context. The authors conducted reflexive thematic analysis.
Findings
The analyses revealed five key strategies, including managing workload, flexible working time arrangements, location of work, mental health check-ups and long-term support. The interviewed line managers reported their own lived experiences and that being aware of the limitations of their role, together with training and support from senior management and human resources (HR), enabled them to provide appropriate support.
Practical implications
The five strategies and the barriers and facilitators to implementing these may enable HR to develop policies and procedures to support line managers, including training of line managers.
Originality/value
This is the first study in the UK on line managers’ behaviors to support workers who have returned to work after a period of long-term sickness absence due to CMDs. The identification of such behaviors is paramount to developing organizational policies and practices. The question, however, remains whether employees see these behaviors as effective.
... Social support has been emphasized as an important factor in determining RTW [48]. Many European countries have developed employer guidelines for information, legislation, and practical advice on how to support cancer patients [49]. However, a UK study revealed that > 70% of employers do not yet have formal policies to manage employees diagnosed with cancer [50]. ...
Purpose: The purpose of this study was to investigate return to work support and related factors of young adult cancer survivors.
Methods: This is a cross-sectional study. Data were collected from 134 young adult cancer survivors, and analyzed using IBM SPSS statistics 26.0 through descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficient, and stepwise multiple linear regression.
Results: The most influential factors affecting the need to return to work were related to type of cancer. Return to work support was higher for cancer survivors treated with urological cancer (β = -0.29, p = .007) compared with gynecological cancer, for those who received fewer treatments (β = -0.23, p = .007), and those experiencing cancer fatigue (β = 0.19, p = .012). For those experiencing recurrence and metastasis, the need to return to work was less than for those not (β = 0.25, p = .004).
Conclusion: Effective and practical interventions to enable a return to work among young adult cancer survivors should be developed and provided considering disease-related characteristics and fatigue, such as diagnosed cancer, recurrence and metastasis, and the number of cancer treatments received.
Implications for Cancer Survivors: Cancer survivors' health care providers and return to work stakeholders may consider developing effective strategies that reflect the diverse needs and characteristics of the growing number of young cancer survivors to successfully return to work.
... person responsible for managing their return) carried out to support their RTW. The line manager behaviour questionnaire [39,40] will be adapted for this purpose. ...
... Participants will also be asked what actions they carried out to support the return of their worker. The measure for supervisors to support return to work (SSRW) [39,40] will be adapted for this purpose. ...
Background
The cost of sickness absence has major social, psychological and financial implications for individuals and organisations. Return-to-work (RTW) interventions that support good quality communication and contact with the workplace can reduce the length of sickness absence by between 15 and 30 days. However, initiatives promoting a sustainable return to work for workers with poor mental health on long-term sickness absence across small, medium and large enterprises (SMEs and LEs) are limited. This paper describes the protocol of a pilot randomised controlled trial (RCT) to test the feasibility of implementing a RTW intervention across SMEs and LEs across all sectors.
Methods and design
A two-arm feasibility RCT with a 4-month intervention will be conducted in SMEs and LE enterprises from the Midlands region, UK. At least 8 organisations (4 controls and interventions), and at least 60 workers and/or managers, will be recruited and randomised into the intervention and control group (30 interventions, 30 controls). Workers on long-term sickness absence (LTSA) (between 8 and 50 days) and managers with a worker on LTSA will be eligible to participate. The intervention is a behavioural change programme, including a managers and workers RTW toolkit, focused on supporting sickness absence and RTW through the provision of knowledge, problem-solving, action planning, goal setting and positive communication that leads to a sustainable RTW. Organisations assigned to the control group will continue with their usual practice. Measurements of mental health, RTW, work outcomes, quality-of-life, workplace support and communication and other demographic data will be taken at baseline, 2 months and 4 months. Feasibility will be assessed based on recruitment, retention, attrition, completion of measures and intervention compliance for which specific process and research outcomes have been established. A process evaluation will explore the experiences and acceptability of the intervention components and evaluation measures. Exploratory economic evaluation will be conducted to further inform a definitive trial.
Discussion
This is a novel intervention using a worker-manager approach to promote a sustainable return to work of workers on long-term sick leave due to poor mental wellbeing. If this intervention is shown to be feasible, the outcomes will inform a larger scale randomised control trial.
