Working while ill, going on sick leave and return to work again: the individual's perspective in primary health care

Abstract: The overall purpose of the present thesis was to increase understand-ing of the dynamic process between working while feeling ill, going on sick leave, and returning to work among people seeking care at primary healthcare (PHC). The present thesis aimed to emphasise the individu-al’s perspective on this process. Methods and aims: Study I used a quantitative design, and studies II, III, and IV used a qualitative design. Following the dynamic process be-tween work and sick leave, each of the four studies had specific aims. The process started with study I, investigating whether reasons for seeking care and self-rated health (SRH) could predict registered sick leave at a 12-month follow-up in non-sick-listed employed women and men seeking care at PHC centres for physical and/or mental symptoms. Study II explored a work-directed intervention, and what factors were important for sustainable work, from the perspective of workers with common mental disorders (CMD). Study III focused on how people on sick leave for various reasons experienced return to work self-efficacy (RTWSE). The final step in the process, study IV, explored how people on sick leave with CMD experienced rehabilitation coordination (RC). Results: Study I showed that a high number of reasons for seeking care and a lower SRH were determinants for sick leave in 12 months. The main reasons for seeking care were mental symptoms and musculo-skeletal pain, and significant differences in proportions concerning symptoms between the groups with and without sick leave in 12 months were found. The work-directed intervention in study II in-creased the participants’ belief in their capacity through supported re-flection and practice. In study III, RTWSE emerged as a global phenomenon influenced by work capacity, a will to be independent and able to partic-ipate in society, and support from others. In study IV, RC was experi-enced as a bridge with many bricks between the person and society with the goal of improving health and returning to work. The bricks reflected the complex context of RC. Conclusions: For people with comorbidity, a lower SRH, or CMD, it may be important to offer preventive rehabilitation interventions as these groups have an increased risk of sick leave. People with CMD experi-ence that preventive rehabilitation interventions by means of occupa-tional therapy and physiotherapy increase their self-efficacy and could strengthen work ability. For a sustainable return to work (RTW) it seems important that interventions not only involve the person but also include the workplace. RTWSE is perceived as a global phenomenon by people on sick leave, influenced by their own driving forces as well as the surrounding environment, and it is an influential phenomenon to consider in rehabilitation. RC is experienced as an important link be-tween healthcare and work by people with CMD. However, information about RC needs to be more available to increase its accessibility.