Published online 2020 Feb 7
ABSTRACT
Background
Working with a chronic condition can be challenging. Providing support to workers with a chronic condition can help them to stay at work and prevent work-related problems. Workers with a chronic condition who successfully stay at work can provide valuable input for the development of effective supportive interventions to prevent exit from work and facilitate sustainable employment. The aim of this study is to explore the lived experiences of workers with a chronic condition and identify existing barriers, facilitators and possible support needs for staying at work.
Methods
Four focus groups were conducted between August and December 2017 with workers with one or more chronic conditions (n = 30). Participants included employees and (partially) self-employed workers. All focus group data were transcribed verbatim and thematically analyzed.
Results
Disclosure and expressing one’s needs were considered important personal facilitators for staying at work. Environmental facilitators included receiving practical information on working with a chronic condition and social and employer support. Environmental barriers were identified in the work environment, the health care system and service provision, e.g., manager and co-worker’s lack of knowledge about working with a chronic condition, a lack of focus on work in the course of treatment for a chronic condition, dissatisfaction with occupational physician support, and the absence of support for self-employed workers. Provided support should be available to all workers, and be proactive and tailored to the workers’ specific support needs.
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Conclusions
A variety of facilitators, barriers and support needs were identified in various domains. By addressing environmental barriers (e.g., by integrating work in the course of treatment and creating supportive work environments), sustainable employment by workers with a chronic condition can be promoted.
Keywords: Work, Chronic conditions, Support, Barriers and facilitators, Sustainable employment
Background
Working with a chronic condition can be a struggle, since physical or psychological challenges can hamper work performance, potentially resulting in a loss of productivity, extended or frequent sick leave, or job loss [1–3]. The number of people in the working population with one or more chronic conditions will continue to rise due to a variety of reasons, amongst others an aging population, unhealthy lifestyles and unfavorable working conditions [4, 5]. Although a large percentage of the working population with a chronic condition is able to work, work participation rates among these workers lag behind the general population [6]. Staying at work and prevention of work-related problems among workers with a chronic condition is of significant importance, since return to work after reporting being ill has proven to be difficult [5, 7].
Participation in the workforce positively influences well being and improves quality of life, as it brings purpose to life and fosters socials contacts [8, 9]. Relevant factors enabling workers with a chronic condition to stay at work have been well investigated, and demonstrate that in addition to disease-related factors, personal and environmental factors are critical for sustainable employment [10–12]. A wide variety of interventions have been developed to facilitate sustainable employment for these workers, and are aimed at the work environment (e.g. facilitating work accommodations) or directed at the individual worker (e.g. increasing empowerment and self-management skills) [13–15].
In addition to self-management and empowerment, self-control is a relevant factor for staying at work. Empowerment, self-management and self-control are all concepts that relate to one’s ability to master a life with a chronic condition and maintain quality of life [16–19]. However, some differences between these concepts can be identified. Self-management can, in a broader sense, be defined as the daily management of a chronic condition over the course of the illness, thereby focusing more on managing symptoms, treatments, and the physical and psychosocial consequences of the condition [20]. Although both empowerment and self-control link to gaining control over decisions and actions, empowerment can be considered either a social, cultural, psychological or political process [19]. Whereas self-control seems more an internal process, with self-control being defined as ‘the capacity for altering one’s own responses, especially to bring them into line with standards such as ideals, values, morals, and social expectations, and to support the pursuit of long-term goals’ (p.351) [21]. This also relates to someone’s ability to adapt to new situations [22, 23].
Proceeding from the new definition of health from Huber, ‘having the ability to adapt and self-manage’ (p. 2) [24], having higher levels of self-control at work and the possibility of exerting self-control can improve well being and health. This then facilitates sustainable employment for workers with a chronic condition. Encouraging people with a chronic condition to take control over their lives and their work has been a focal point of the Dutch government and society for a long time [25]. In a qualitative synthesis on self-control of workers with a chronic condition, we specified the desired behaviors that are important to staying at work and the influence of these behaviors and their interaction with the environment. The study findings also showed the importance of support for exerting self-control [26].
Exerting desired self-control behaviors is often not enough to stay at work for workers with a chronic condition. Adequate support is also critical, as stated by the European Chronic Disease Alliance [5]. Research has already shown the positive effects of a supportive work environments for workers with a chronic condition [27]. However, other domains, such as occupational health services and medical health care have an important supportive role as well [28, 29]. National policies can also have an important influence on sustainable employment of workers with a chronic condition [5]. Effective supportive interventions can help workers with a chronic condition to stay at work and achieve sustainable employment. However, workers’ specific support needs must first be identified. Workers with a chronic condition who are successful in staying at work can provide valuable input for these supportive interventions. Therefore, the aim of this study is to explore the lived experiences of Dutch workers with a chronic condition who are successful in staying at work, and identify facilitating factors, existing barriers and possible support needs for staying at work.
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