TNO Work and Employment, PO Box 718, 2130 AS Hoofddorp, the Netherlands.
BMC Public Health. 2011 Jan 3;11:1. doi: 10.1186/1471-2458-11-1.
Variation in assessments is a universal given, and work disability assessments by insurance physicians are no exception. Little is known about the considerations and views of insurance physicians that may partly explain such variation. On the basis of the Attitude--Social norm--self Efficacy (ASE) model, we have developed measurement instruments for assessment behaviour and its determinants.
Based on theory and interviews with insurance physicians the questionnaire included blocks of items concerning background variables, intentions, attitudes, social norms, self-efficacy, knowledge, barriers and behaviour of the insurance physicians in relation to work disability assessment issues. The responses of 231 insurance physicians were suitable for further analysis. Factor analysis and reliability analysis were used to form scale variables and homogeneity analysis was used to form dimension variables. Thus, we included 169 of the 177 original items.
Factor analysis and reliability analysis yielded 29 scales with sufficient reliability. Homogeneity analysis yielded 19 dimensions. Scales and dimensions fitted with the concepts of the ASE model. We slightly modified the ASE model by dividing behaviour into two blocks: behaviour that reflects the assessment process and behaviour that reflects assessment behaviour.The picture that emerged from the descriptive results was of a group of physicians who were motivated in their job and positive about the Dutch social security system in general. However, only half of them had a positive opinion about the Dutch Work and Income (Capacity for Work) Act (WIA). They also reported serious barriers, the most common of which was work pressure. Finally, 73% of the insurance physicians described the majority of their cases as 'difficult'.
The scales and dimensions developed appear to be valid and offer a promising basis for future research. The results suggest that the underlying ASE model, in modified form, is suitable for describing the assessment behaviour of insurance physicians and the determinants of this behaviour. The next step in this line of research should be to validate the model using structural equation modelling. Finally, the predictive value should be tested in relation to outcome measurements of work disability assessments.
评估中的差异是普遍存在的，保险医师的工作能力丧失评估也不例外。对于可能部分解释这种差异的保险医师的考虑因素和观点知之甚少。基于态度-社会规范-自我效能（ASE）模型，我们已经开发了评估行为及其决定因素的测量工具。
基于理论和对保险医师的访谈，问卷包括与背景变量、意图、态度、社会规范、自我效能、知识、障碍以及与工作能力丧失评估问题相关的保险医师行为相关的项目。对 231 名保险医师的回复进行了进一步分析。使用因子分析和可靠性分析形成量表变量，使用同质性分析形成维度变量。因此，我们纳入了 177 个原始项目中的 169 个。
因子分析和可靠性分析产生了 29 个具有足够可靠性的量表。同质性分析产生了 19 个维度。量表和维度与 ASE 模型的概念相吻合。我们通过将行为分为反映评估过程的行为和反映评估行为的行为两个模块，对 ASE 模型进行了略微修改。描述性结果所呈现的图景是，一群对工作有动力、对荷兰社会保障制度总体持积极态度的医生。然而，只有一半的人对荷兰《工作和收入（工作能力）法》（WIA）持积极看法。他们还报告了严重的障碍，最常见的是工作压力。最后，73%的保险医师将他们的大部分病例描述为“困难”。
所开发的量表和维度似乎是有效的，为未来的研究提供了有希望的基础。结果表明，经修正后的 ASE 模型适合描述保险医师的评估行为及其行为的决定因素。下一步研究应使用结构方程模型验证该模型。最后，应在工作能力丧失评估的结果测量方面测试其预测值。
