Environmental and personal factors that support early return-to-work: a qualitative study using the ICF as a framework

BACKGROUND: Occupational health professionals such as occupational physicians (OPs) increasingly understand that in addition to health improvement, environmental factors (such as work adaptations) and personal factors (such as an employee's attitude towards return-to-work (RTW)) may stimulate employees on sick leave to return to work early. To target their professional interventions more specifically according to these factors, occupational health professionals need further insight into environmental and personal factors that stimulate RTW. OBJECTIVE: The objectives of this study are (1) to identify which and how environmental and personal factors support RTW, and (2) to examine whether the International Classification of Functioning, Disability and Health (ICF) can be used to describe these factors. METHODS: We performed interviews with 14 employees, 15 employers and 4 OPs from multiple organisations with varying organisational sizes and types of industry such as healthcare and education. We used a qualitative data analysis partially based on the Qualitative Analysis Guide of Leuven. RESULTS: The following environmental factors were found to support early RTW: 'social support from relatives', 'belief that work stimulates health', 'adequate cooperation between stakeholders in RTW' (e.g. employees, employers and OPs) and 'the employers' communicative skills'. One personal factor stimulated RTW: 'positive perception of the working situation' (e.g. enjoyment of work). Most factors stimulated RTW directly. In addition, adequate treatment and social support stimulated medical recovery. Environmental factors can either fully (social support, belief that RTW stimulates health), partially (effective cooperation), or not (employers' communicative skills) be described using ICF codes. The personal factor could not be classified because the ICF does not contain codes for personal factors. CONCLUSIONS: RTW interventions should aim at the environmental and personal factors mentioned above. Professionals can use the ICF to describe most environmental factors.