New IMM thesis on problem-solving intervention at sickness absence

Time: June 14 at 9.00 AM
Location: Rockefeller (Nobels väg 11, entréplan). Karolinska Institutet, Solna
Supervisor: Elisabeth Björk Brämberg, Principal researcher, Institute of Environmental Medicine (IMM)
Opponent: Professor Evelien Brouwers, Dept. of Tranzo/Scientific Center for Care and Wellbeing, Div. of Tilburg School for Social and Behavioural Sciences, Tilburg University

Three questions to Ida

What is the thesis about?

The thesis evaluates a problem-solving intervention in combination with workplace involvement. The intervention was delivered by rehabilitation coordinators at primary care in Sweden to employees on sickness absence due to common mental disorders and compared to care-as-usual in a randomized controlled trial. The intervention was evaluated in four studies. The first study was an effect evaluation looking at the number of days on sickness absence during an 18-month follow-up period. The second study explored facilitating and hindering factors to participate in the intervention. The third study explored ethical challenges potentially arising from participating in the intervention. The fourth study was a process evaluation that evaluated process outcomes.

Can you tell us about some interesting results?

The process evaluation showed that employees receiving the intervention received more sessions with the coordinator and more meetings with their manager, despite this both groups had a similar decrease in sickness absence days over time. We need to understand more about why we did not see a difference between the intervention and control group. The similar decrease in sickness absence days may be caused by a lack of contrast between the intervention and control group and by the Swedish social security regulations which evaluates the employees’ right to sickness absence at specific time-points.  

In the interviews with coordinators, employees, and managers it was reported that the structure of the intervention facilitated the return-to-work process. Moreover, the employees were facilitated by learning to identify problems and solutions for returning to work, but the intervention was more time consuming than care-as-usual and dependent on good relationships. Ethical challenges were identified on the organisational level, in terms of differences between the goals and values of the healthcare and the workplace, and on the individual level, in terms of disclosure dilemmas and unclear roles for the coordinator and manager. We recommend that coordinators are made aware of these challenges to be able to support employees and managers during the return-to-work process. 

What further research is needed in the area?

• We need to understand more about which combination of interventions are effective on return-to-work outcomes.
• We need to explore implementation strategies that can increase compliance with the different steps of the intervention. 

• We also need a better understanding of which group of employees needs support with returning to work. This knowledge would support the primary health care in distributing their resources.

  Read the thesis