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On the nature of work ability
Jönköping University, School of Health and Welfare, HHJ. ADULT.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

‘Work ability’ is a multidimensional concept with importance for both society and the individual. The overall aim of this thesis was to illuminate work ability from the perspective of individuals (Studies I, III), rehabilitation (Study II) and employers (Study IV). In Study I five focus-group interviews were conducted with a total of 16 former unemployed sickness absentee participants. The interviews focused on their experiences of the environmental impact on return to work. The participants expressed a changed self-image and life rhythm. A need for reorientation and support from professionals was stressed. Experiences of being stuck in a ‘time quarantine’, i.e. a long and destructive wait for support, were also revealed. Study II was a randomised controlled study evaluating the interventional capacity of problem-based method (PBM) groups regarding anxiety, depression and stress and work ability compared to cognitive behavioural therapy (CBT) as a method within the Rehabilitation Guarantee. Effects were measured with psychometric instruments. The participants, 22 in the PBM group and 28 in the CBT group, were persons on sick leave because of common mental disorders. Within-group analysis showed significant lower degree of symptoms regarding anxiety and depression for both interventions. Between-group analysis showed significant lower degree of symptoms for CBT regarding anxiety, depression and stress. Within-group analysis of work ability showed significant improvement in one (out of five) subscales for the PBM group and in four for the CBT group. No significant between-group differences were found regarding work ability. In Study III, 16 participants were interviewed after completed interventions in Study II, eight from each intervention group. The interviews focused on their experiences from the interventions and the impact on their ability to work and perform other everyday activities. The interventions were experienced as having a positive impact on their ability to work and perform other everyday activities in a more sustainable way. Reflecting on behaviour and achieving limiting strategies were perceived as helpful in both interventions, although varying abilities to incorporate strategies were described. The findings support the use of active coping-developing interventions rather than passive treatments. Study IV included interviews with 12 employers and investigated their conceptions of ‘work ability’. In the results three domains were identified: ‘employees’ contributions to work ability’, ‘employers’ contributions to work ability’ and ‘circumstances with limited work ability’. Work ability was regarded as a tool in production and its output, production, was the main issue. The employees’ commitment could bridge other shortcomings. In summary, in the work rehabilitation process, different perspectives on work ability need to be considered in order to improve not only individual performance but also rehabilitation interventions, work-places and everyday circumstances. Clearly pronounced perspectives can contribute to better illustrating the dynamic within the relational and multifaceted concept of ‘work ability’. The ability to work can thus be enhanced through improving individual abilities, discovered through reorientation and created through support and adaptation.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences , 2014. , 120 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 48
Keyword [en]
context, disability, occupational therapy, participation, work demand
National Category
Occupational Therapy
Identifiers
URN: urn:nbn:se:hj:diva-23610ISBN: 978-91-85835-47-8 (print)OAI: oai:DiVA.org:hj-23610DiVA: diva2:705046
Public defence
2014-04-11, Forum Humanum, 13:00 (English)
Opponent
Supervisors
Available from: 2014-03-14 Created: 2014-03-14 Last updated: 2015-10-23Bibliographically approved
List of papers
1. The Experience of Returning to Work
Open this publication in new window or tab >>The Experience of Returning to Work
2007 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 28, no 2, 121-134 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this qualitative study was to explore from an environmental perspective the experiences of returning to work of former unemployed sickness absentees. Five separate focus-group interviews were carried out with themes concerning different environmental areas. The findings showed that the participants in their process of being off work and then attempting returning to work experienced a personal transition manifesting itself as a negative self-image, change of life-rhythm and restrictions in their roles and activities. In their progression, the participants experienced a need for reorientation and expressed feelings of alienation, and for that reason felt need of support from a network, especially a professional one. Regarding attitudes in society, the participants reported experiences of social stigmatization, both in mass media and in their immediate social environment, and an increasing egocentricity among their fellow-workers. They perceived their progression back to work as a ‘time quarantine’ and as a long and destructive wait for support. The findings indicate that the phenomenon of ‘returning to work’ after unemployment and sick leave could not be reduced to a single issue. It should rather be seen as a dynamic problem with individual and structural, environmental aspects.

Keyword
Attitudes, coherence, focus group, former unemployed, vocational rehabilitation, personal transition, reorientation, sick-listed absentees, time
National Category
Occupational Therapy
Identifiers
urn:nbn:se:hj:diva-6207 (URN)17312344 (PubMedID)
Available from: 2007-11-08 Created: 2007-11-08 Last updated: 2017-12-12Bibliographically approved
2. Problem-based self-care groups versus cognitive behavioural therapy for persons on sick leave due to common mental disorders: A randomised controlled study
Open this publication in new window or tab >>Problem-based self-care groups versus cognitive behavioural therapy for persons on sick leave due to common mental disorders: A randomised controlled study
Show others...
2015 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 1, 127-140 p.Article in journal (Refereed) Published
Abstract [en]

Purpose To evaluate the interventional capacity of problem based method groups (PBM) regarding mental health and work ability compared to cognitive behavioural therapy (CBT) for persons on sick leave due to common mental disorders. Methods In a randomised controlled design the experimental group received PBM and the control group received CBT. Outcomes were measured by the Hospital Anxiety and Depression Scale (HADS), the Stress and Crisis Inventory 93 (SCI-93) and the Dialogue about Working Ability instrument (DOA). Results Twenty-two participants in the PBM group and 28 in the CBT group completed intervention. Both groups showed significant lower scores on the two HADS subscales. Regarding stress the PBM group showed significant decrease in one (out of three) subscales of SCI-93. The CBT group showed significant decrease on all subscales of SCI-93. Regarding work ability the PBM group showed significant higher scores on one of five subscales of DOA. The CBT group showed significant higher scores on four of five subscales of DOA. Between groups there were significant differences to the favour of CBT on one of two subscales of HADS, all three subscales of SCI-93 and on two of the five subscales of DOA. Conclusion PBM seem to be able to reduce anxiety- and depression symptoms. CBT showed to be superior to PBM in reducing symptoms in all aspects of mental health, except for anxiety, in which they seem equally effective. Regarding work ability CBT showed to be superior, with significant effect on more aspects compared to PBM.

Keyword
Anxiety, Depression, Intervention, Primary health care, Return to work, Sickness absence, Stress
National Category
Occupational Therapy
Identifiers
urn:nbn:se:hj:diva-28210 (URN)10.1007/s10926-014-9530-9 (DOI)000349971100013 ()24972663 (PubMedID)2-s2.0-84939873309 (Scopus ID)
Funder
Vårdal FoundationMedical Research Council of Southeast Sweden (FORSS)
Available from: 2015-10-23 Created: 2015-10-23 Last updated: 2017-12-01Bibliographically approved
3. Work and everyday activities: Experiences from two interventions addressing people with common mental disorders
Open this publication in new window or tab >>Work and everyday activities: Experiences from two interventions addressing people with common mental disorders
2014 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 21, no 4, 295-304 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Lengthy sick leave makes demands on work ability enhancing interventions in primary health care. Problem-based method (PBM) and cognitive behavioural therapy (CBT) are interventions aimed at people with common mental disorders. This study aimed to describe how individuals experienced interventions and the impact the interventions had on the individuals' ability to work and perform other everyday activities. Method: Fourteen women and two men, eight each from two interventions, were interviewed. The interviews were analysed using qualitative content analysis. Results: The analysis revealed one overarching theme: "Reaching safe ground or continuing to seek help". Four categories were identified: "From being passive to making one's own efforts in the rehabilitation process", "Being stuck on a treadmill or daring to change", "Evolving from routine to more aware behaviour", and "Fitting in or not fitting in with workplace situations". Conclusions: According to the participants, experiences from both PBM and CBT had a positive impact on their ability to work and perform other everyday activities in a more sustainable way. Reflecting on behaviour and achieving limiting strategies were perceived as helpful in both interventions, although varying abilities to incorporate strategies were described. In general, the results support the use of active coping-developing interventions rather than passive treatments.

Keyword
Anxiety, cognitive behavioural therapy, depression, interview, problem-based method, qualitative content analysis, sick leave, stress, Swedish rehabilitation guarantee, vocational rehabilitation
National Category
Occupational Therapy
Identifiers
urn:nbn:se:hj:diva-25911 (URN)10.3109/11038128.2014.894572 (DOI)000338115100006 ()24666197 (PubMedID)2-s2.0-84903145243 (Scopus ID)
Available from: 2015-02-18 Created: 2015-02-18 Last updated: 2017-12-04Bibliographically approved
4. The concept of 'work ability' from the view point of employers
Open this publication in new window or tab >>The concept of 'work ability' from the view point of employers
2015 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 52, no 1, 153-167 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Since work ability is manifested in working life and "bought" by employers, employers perceptions of the concept are important to understand. Studies have shown that people with health problems want to take part in the labour market, but experience difficulties in gaining access. Additionally, studies have demonstrated the doubt felt by employers when they consider hiring a person with a disability.

OBJECTIVE: The aim was to identify and characterise employers' conceptions of work ability.

METHODS: The study design was qualitative with a phenomenographic approach. Six male and six female employers from various workplaces and geographical areas in Sweden were interviewed.

RESULTS: Three domains were identified: employees' contributions to work ability, employers' contributions to work ability and circumstances with limited work ability. Work ability was regarded as a tool in production and its output, production, was the main issue. The employees' commitment and interest could bridge other shortcomings.

CONCLUSIONS: The employers highlighted their own contributions in shaping work ability in order to fit with work circumstances. Health problems were not the only limiting issues; other circumstances, such as individual characteristics and contextual factors, could limit work ability too. Knowing the importance of commitment and interest is valuable in work rehabilitation.

Keyword
Disability, vocational rehabilitation, work demand
National Category
Occupational Therapy
Identifiers
urn:nbn:se:hj:diva-28212 (URN)10.3233/WOR-152037 (DOI)000362142300015 ()26410230 (PubMedID)2-s2.0-84940558033 (Scopus ID)
Available from: 2015-10-23 Created: 2015-10-23 Last updated: 2017-12-01Bibliographically approved

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