Self-Efficacy and Work-Related Factors Associated with Return to Work in a Vocational Rehabilitation Programme with a Lifestyle Focus – A Prospective Observational Study A Fully Integrated Mixed Methods Research Design. A Fully Integrated Mixed Methods Research Design

Abstract

This thesis aims to examine self-efficacy and work-related factors associated with return to work in a vocational (VR) programme with a lifestyle focus for people on, or at risk of, sick leave due to obesity or obesity-related problems. Obesity or obesity-related problems may cause work disabilities which can lead to reduced productivity for the individual as a member of society. One of the most important determinants of health differences in society is being out of work due to disability, leading to a national problem due to increased income loss compensation. Therefore, in Norway, people with work disabilities can participate in VR programmes. Traditional VR programmes tend to last for no more than four weeks and, occasionally, up to twelve weeks. This stands in stark contrast to the length of time needed for necessary lifestyle changes, which should preferably be implemented over a minimum of a six-month period. However, in 2015, a new, temporary, multidisciplinary VR programme for people with obesity was established. The programme aimed to promote return to work (RTW) and reduce the consequences of obesity. A literature review revealed sparse published research literature in the cross-disciplinary fields of weight loss and RTW. None of the published studies examined VR programmes with a lifestyle focus. Therefore, five research questions (RQs) were formulated to examine the participants' behaviour and attitudes in order to answer the RQ 6 of this thesis. 1. What associations are there between the 12-month vocational rehabilitation (VR) programme and changes in health-related quality of life (HRQoL), body mass index kg/m2 (BMI), return to work self-efficacy (RTWSE), work ability scale (WAS), and degree of work participation (DWP) from baseline to 12-month follow-up? 2. What associations are there between the 12-month vocational rehabilitation (VR) programme and changes in HRQoL in relation to changes in the other outcome variables BMI, RTWSE, WAS, DWP and work absence? 3. What changes from baseline to 12-month follow-up in HRQoL, BMI, and RTWSE, in combination with return to work expectations (RTWEXP), are associated with WAS at 12-month follow-up? 4. What changes in HRQoL, BMI, RTWSE, and WAS, in combination with return to work expectations, are associated with DWP at 12-month follow-up? 5. What self-efficacy influences the participants' experiences, attitudes, and viewpoints regarding the association between work, health and lifestyle factors that influence work participation two to four years after completing the new VR programme with lifestyle intervention. 6. What self-efficacy and work-related factors are associated with return to work in a vocational rehabilitation programme with a lifestyle focus? Questionnaires, body composition tests, registry data, and journal data measured the participants' behaviour in RQs 1 to 4 (study 1). Focus group (FG) interviews contributed to examining the participants' attitudes in RQ 5 (study 2). In RQ 6, studies 1 and 2 were combined and integrated into the discussion chapter of this thesis. Combining data in this way is called a mixed-method design. Behaviour was analysed with descriptive statistics. The difference between baseline to 12-month follow-up was analysed with a paired sample t-test, and simple and multiple linear regression analyses were performed to examine the association between changes in explanatory variables with outcome measures. Attitudes were analysed with Braun and Clarke’s six-phase reflexive thematic analysis (RTA) approach, which involves familiarising data, data coding, searching for themes, reviewing themes, defining and naming themes and producing the report. Results from RQ 1, from baseline to 12-month follow-up, indicated statistically significant changes in HRQoL, BMI, WAS, RTWSE and DWP. Analyses in RQ 2 demonstrated that BMI, RTWSE, WAS, DWP and work absence was significantly associated with the outcome measure HRQoL at 12-month follow-up. The regression model explained 71.8% of the HRQoL variance. Analyses in RQ 3 demonstrated that education level, WAS baseline, and change in HRQoL were significantly associated with the outcome measure WAS at 12-month follow-up. The regression model explained almost 50% of the variation in WAS. In RQ 4, the final multivariate linear regression analysis demonstrated that RTWEXP at baseline was significantly associated with the outcome measure DWP at 12-month follow-up. The regression model explained almost 30% of the variation in the outcome measure DWP. In RQ 5, one main theme ‘Work participation enhances quality of life’, and four sub-themes ‘My attitude to life’, ‘Body size matters’, ‘Good physical capacity enhances everyday life’, and the last, ‘Support from the surroundings’ emerged from the analysis and consisted of information affecting the participants’ self-efficacy concerning work participation. The thesis findings are presented within the Best Practice Models of Return to Work (BPRTW) three phases and the overall societal structure. The stay at work phase consists mainly of findings from study 2 supplemented with findings from study 1. The early RTW phase consists mainly of findings from study 1 supplemented with findings from study 2. The prolonged RTW phase and organisational structures consist of findings from study 2. The findings of this thesis may be a valuable contribution to the sparse literature described in chapter 1.5. The findings may also increase knowledge about VR programmes with lifestyle focus for people who are on or are at risk of sick leave due to obesity or obesity-related problems. Another contribution is updated knowledge in the field of weight loss and RTW. Last, the published results from Studies 1 and 2 may increase attention to obesity as a chronic disease with its implications for both individuals and society.