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Designing a Process Evaluation to Examine Mechanisms of Change in Return to Work Outcomes Following Participation in Occupational Rehabilitation: A Theory-Driven and Interactive Research Approach
- Ulrik Gensby, Tore Norendal Braathen, Chris Jensen, Monica Eftedal
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- Published online by Cambridge University Press:
- 28 June 2018, e1
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There is a growing consensus that professional action in occupational rehabilitation should be research-based, and that practice-based knowledge is needed to achieve contextual insight and new theoretical understanding. Few study design examples exist to help inform an evaluation plan and develop research-practice interactions to examine process complexity of targeted occupational rehabilitation programs. This study design article is a proposal on a theory-driven and interactive research methodology for a process evaluation of a pragmatic intervention trial, known as STAiR. The aim of the process evaluation is to examine the delivery and implementation of an inpatient and an outpatient occupational rehabilitation program, and explore active mechanisms pertaining to patient experiences of the return to work (RTW) process. Qualitative and interactive data collection methods will include (a) participant observation of program setting and activities; (b) participatory dialogue conferences with program providers to facilitate initial logic modelling; (d) individual patient interviews at program intake and follow up; and (d) focus groups with rehabilitation teams and external stakeholders. The qualitative data will be supplemented with description of program activities and patient questionnaires. Program logic modelling is suggested to inform a logic analysis of how expected RTW outcomes and delivery of program activities are aligned and how contextual characteristics may clarify differences in achieved RTW outcomes. The proposed process evaluation approach may inform future design discussions and theoretical understanding, and it is expected that the applied knowledge gained through this study may help rehabilitation professionals better navigate potential challenges in clinical evaluation efforts.
Employment in Northern Ireland's Civil Service: Social Barriers and Hyperbole Mean Disabled Need Not Apply
- Jason Olsen
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- Published online by Cambridge University Press:
- 09 July 2018, e2
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The representation of people with disabilities in the Northern Ireland Civil Service (NICS) is approximately 44% less than that seen in the civil services of the United States (US) and Great Britain (GB; i.e., the United Kingdom sans Northern Ireland). Various proactive approaches to employing people with disabilities are cited for the success of the US and GB's efforts to increase the representation of disabled people in their civil services. This is important because governments as employers can be the catalyst for large-scale social change. The US and GB governments have demonstrated an intention to be this catalyst. They have done this by (a) establishing goals for the hiring of disabled people; (b) naming executives responsible for reaching these hiring goals; (c) utilising special hiring authorities; (d) executing guaranteed interview schemes; and (e) applying regulations and laws designed to employ and protect people with disabilities. These activities could be adopted in Northern Ireland (NI) to address the current inequalities in the NICS. However, the question remains whether a government that believes it has achieved disability equality in its civil service, despite comparators that say otherwise, can or will make such a concerted effort. An analysis of over 60 US, GB, and NI government and assembly documents, reports, and laws are examined and compared through the lens of critical disability theory (CDT) to identify the disconnect between the representations and the reality of figures presented about the inclusion of those with disabilities in the NICS.
The Role of Healthcare Providers in Return to Work
- Agnieszka Kosny, Marni Lifshen, Basak Yanar, Sabrina Tonima, Ellen MacEachen, Andrea Furlan, Mieke Koehoorn, Dorcas Beaton, Juliette Cooper, Barbara Neis
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- Published online by Cambridge University Press:
- 03 August 2018, e3
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International research has generated strong evidence that healthcare providers (HCPs) play a key role in the return to work (RTW) process. However, pressure on consultation time, administrative challenges and limited knowledge about a patient's workplace can thwart meaningful engagement. Aim: Our study sought to understand how HCPs interact with workers compensation boards (WCBs), manage the treatment of workers compensation patients and navigate the RTW process. Method: The study involved in-depth interviews with 97 HCPs in British Columbia, Manitoba, Ontario and Newfoundland and Labrador and interviews with 34 case managers (CMs). An inductive, constant comparative analysis was employed to develop key themes. Findings: Most HCPs did not encounter significant problems with the workers compensation system or the RTW process when they treated patients who had visible, acute, physical injuries, but faced challenges when they encountered patients with multiple injuries, gradual-onset or complex illnesses, chronic pain and mental health conditions. In these circumstances, many experienced the workers compensation system as opaque and confusing. A number of systemic, process and administrative hurdles, disagreements about medical decisions and lack of role clarity impeded the meaningful engagement of HCPs in RTW. In turn, this has resulted in challenges for injured workers (IWs), as well as inefficiencies in the workers compensation system. Conclusion: This study raises questions about the appropriate role of HCPs in the RTW process. We offer suggestions about practices and policies that can clarify the role of HCPs and make workers compensation systems easier to navigate for all stakeholders.
Return to Work After Long-Term Sick Leave: Stories of Employed Women With Common Mental Disorders
- Erika Wall, John Selander
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- Published online by Cambridge University Press:
- 03 December 2018, e4
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The aim of this study is to investigate the perceptions of female employees on long-term sickness absence due to common mental disorders (CMDs), in relation to what they perceive would best help them to return to work. Data were collected through a survey answered by employees at a municipality in Sweden on long-term sick leave. Results of the current study are based on a part of that material, namely from 56 women with CMDs who responded to the final open question. The analysis involves two steps. Initially, we explored themes that form the accounts in the findings. Secondly, based on the themes, collective narratives, storylines were identified. Three different storylines were found to be prominent in the findings. The storylines describe how the participants collectively expressed themselves in relation to the possibilities for return to work, and the following storylines were derived: It feels like too much, Things are moving too fast, and I have to get out of here!. The findings are related to perceived demands, control and support. From a disability management perspective, we have learned the importance of restoring the balance between demands, control and support — not only to prevent absence from work, but also to facilitate return to work after a period of long-term sickness.
Expanding Freedoms of People With Visual Impairment Through Information and Communication Technologies: Narratives From Bangladesh
- Md Kamrul Hasan, Mahfuz Ashraf, Padmanesan Narasimhan, Rimjhim Aggarwal
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- Published online by Cambridge University Press:
- 03 December 2018, e5
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Information and communication technologies (ICTs) have become an element of strategic importance to all countries. Researchers argue that ICTs may open up new avenues for economic growth, competitiveness and human development. It is widely recognised that ICTs have the potential of overcoming many of the barriers faced by people with visual impairment (VI). Based on an interpretive study using the narrative interview method, this article contributes to this literature by presenting perceptions and understandings of how the use of ICTs can be used to promote the ‘development’ of people with VI in Bangladesh. We approached this study through the economist and Nobel Laureate Amartya Sen’s work on ‘development as freedom’ that focuses on, among other themes, five dimensions of freedom — social, economic, protective, political and transparency. We collected stories from 18 people with VI who had received ICTs training and support from resource centres, and from some disability rights activists and leaders who use ICTs. Our findings suggest that ICTs can be used as tools for improving the wellbeing of people with VI by enhancing different aspects of freedom suggested by Sen. ICTs tools assist people with VI by providing them with educational and work opportunities, and thus increase the potential for social inclusion and economic development. We conclude that governments, nongovernment organisations and development partners in countries such as Bangladesh may use ICTs to expand different types of ‘freedom’ for marginalised groups such as people with VI and persons with disabilities in general.