Working with a chronic condition: Strengthening self-control in a supportive work environment

Working with a chronic condition can be challenging, with physical or psychological limitations hampering work performance. Since return to work after long-term sick leave has proven to be difficult, prevention of work-related problems and facilitating sustainable employment among workers with chronic conditions is of significant importance. Self-control can help workers with chronic conditions to stay at work. Self-control relates to one’s ability to adapt to a new challenging situation. Having higher levels of self-control at work might improve wellbeing and health, thereby facilitating sustainable employment of workers with chronic conditions. However, not every worker has the same level of self-control. By creating a supportive work environment, workers with chronic conditions are enabled to exert self-control, so that work-related problems can be prevented. Both stakeholders within occupational health care and within organizations should play a role in providing support to workers with chronic conditions. However, currently, occupational physicians (OPs) in the Netherlands spend most of their time on reducing sickness absence instead of on preventive activities. This thesis aimed to develop, implement and evaluate an organizational-level intervention to prevent work-related problems, by strengthening self-control among workers with chronic conditions. The primary objectives of this thesis were: 1. To explore the elements of self-control at work from the perspectives of workers with chronic conditions and to gain insight in contextual factors that influence its exertion. 2. To explore facilitators, barriers and support needs for staying at work among workers with chronic conditions and to identify barriers to offering support and opportunities for improving support from the perspectives of OPs and organizational representatives. 3. To develop and evaluate an organizational-level intervention, in which OPs guide organizations with creating a supportive work environment for workers with chronic conditions. In chapter 2, a qualitative synthesis was conducted that defines the elements of self-control and presents the contextual factors that influence its exertion. This study showed us four elements of self-control: 1) disclosure, 2) finding a healthy balance, 3) requesting work accommodations and support, and 4) management of symptoms and limitations in the workplace. Moreover, it illustrated that especially the work environment is of importance for the level of self-control at work. In chapter 3, a focus group study was performed in which the lived experiences of workers with chronic conditions were explored. Disclosure and expressing one’s needs are considered important facilitators for staying at work. Furthermore, several environmental facilitators were identified, including employer support. Chapter 4 describes the current practices of OPs and organizational representatives. Participants identified barriers to offer support, including barriers at the organizational level, the employee level and in the collaboration between OPs and organizational representatives. Furthermore, OPs and organizational representatives described barriers in occupational health care (e.g. lack of OPs’ visibility). Opportunities to optimize support included actively anchoring prevention of work-related problems in policy and practice. Chapter 5 outlines the development of an organizational-level intervention, using the Participatory Approach (PA), to create a supportive work environment for workers with chronic conditions. OPs fulfilled a key role in the intervention. In chapter 6, the evaluation of a pilot implementation of the intervention is described, including a process evaluation and feasibility study. This study showed that convincing organizations to create a supportive work environment appeared to be a challenge, with three out of 12 organizations willing to apply the PA. The final chapter of this thesis, chapter 7, summarizes and discusses the main research findings. In a broader sense, the barriers to prevention, including preventive support, within organizations, occupational health care and curative health care are considered. In addition, methodological considerations and the implications for research, policy and practice are discussed.