Lettinga Hanneke A M, van Oostrom Sandra H, Zijlstra Hendrika P, Anema Johannes R, Proper Karin I
Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
J Occup Rehabil. 2025 May 16. doi: 10.1007/s10926-025-10301-7.
A stepped care approach, beginning with a low-intensity e-Health program followed by a high-intensity Participatory Approach led by a return-to-work (RTW) coordinator is a promising intervention to promote RTW of employees on sick leave with distress. As this approach is new, determinants of its successful implementation remain unknown. This study aimed to identify the potential facilitators and barriers for a stepped care approach to promote RTW of employees with distress, from the perspective of employees, employers, and occupational physicians.
A qualitative study was performed consisting of individual semi-structured interviews with 10 employees, 5 supervisors, and two focus groups with 15 occupational physicians. The verbatim transcripts were inductively thematically coded. The Consolidated Framework for Implementation Research (CFIR) was applied to classify themes within its domains.
Themes were constructed belonging to either the implementation or the content of the stepped care approach, falling within the CFIR domains "innovation," "outer setting," "inner setting," and "characteristics of the individual." From all three stakeholder groups, identified facilitators were the tailored program, enabling task adjustments, and the RTW coordinator to stimulate a good communicative relationship between employee and supervisor. Barriers identified were the timing of the stepped care approach, integrating the approach in the current RTW system, and low digital skills.
Both facilitators and barriers were found for the implementation of the stepped care approach. This underlines the importance of an adaptive implementation strategy that takes into account workplace dynamics and tailored approaches to support the stakeholder groups' needs.
ISRCTN: 90663076. Registered on October 5, 2023.
一种逐步护理方法，首先是低强度的电子健康计划，然后是由重返工作岗位（RTW）协调员主导的高强度参与式方法，是一种很有前景的干预措施，可促进休病假且伴有困扰的员工重返工作岗位。由于这种方法是新的，其成功实施的决定因素尚不清楚。本研究旨在从员工、雇主和职业医生的角度，确定逐步护理方法促进困扰员工重返工作岗位的潜在促进因素和障碍。
进行了一项定性研究，包括对10名员工、5名主管进行的个人半结构化访谈，以及对15名职业医生进行的两个焦点小组访谈。逐字记录的访谈内容进行了归纳主题编码。应用实施研究综合框架（CFIR）在其领域内对主题进行分类。
构建的主题属于逐步护理方法的实施或内容，属于CFIR领域的“创新”、“外部环境”、“内部环境”和“个体特征”。从所有三个利益相关者群体中确定的促进因素包括量身定制的计划、能够进行任务调整以及RTW协调员促进员工与主管之间良好的沟通关系。确定的障碍包括逐步护理方法的时机、将该方法融入当前的RTW系统以及数字技能较低。
发现了逐步护理方法实施的促进因素和障碍。这强调了一种适应性实施策略的重要性，该策略考虑到工作场所动态以及为满足利益相关者群体需求而量身定制的方法。
ISRCTN：90663076。于2023年10月5日注册。
