Understanding the complexity of lowered work ability: Individuals’ perceptions of factors that affect returning to work after sickness absence

Background: Work ability is a multidimensional issue encompassing a person’s physical and mental health as well as capabilities, work demands, and many social and environmental factors. Lowered work ability is a wicked problem as it has numerous underlying reasons, requires multi-sectoral cooperation and cannot be completely solved as a social problem – only eased. This study has a multidisciplinary approach utilizing literature from public health, work psychology and occupational rehabilitation. The background section introduces the Finnish health care, rehabilitation and benefit systems and some of the recent multi-sectoral and multi-professional models that have been designed to support work ability and returning to work after sick leave. Aims: More qualitative research on factors affecting work ability is needed. Therefore, the overall purpose of this qualitative study is to add knowledge on partial work ability, focusing on individuals’ perceptions of factors that affect returning to work after sick leave. The purpose is divided into two aims: (1) to build a holistic under¬standing of the challenges that sick-listed individuals experience in their quest for resolving their situations and (2) to examine the individuals’ perceptions of available services and other factors that help or hinder them in returning to work. Sixteen individuals with prolonged sickness absence due to a musculoskeletal disease (MSD) participated in semi-structured phone interviews for this study. The interviews included questions on health, work ability, wellbeing, service use and employment. The Social Insurance Institute of Finland (Kela) had contacted the potential interviewees earlier and advised them to contact a TOIKE Work Ability Centre to receive holistic counselling. The analysis process was data-driven and utilized narrative and thematic analysis. Findings: For many, lowered work ability posed a triple-burden of sickness, unemployment and financial difficulties. This study identified five distinctive groups among those with lowered work ability based on their self-assessed health and work ability, orientation towards work or pension, and perceptions concerning their future: (1) The Successful, who had recovered well, were motivated and had returned to work. (2) The Persevering, who had not recovered well but had returned to work despite persisting work ability concerns. (3) The Forward-looking, who had not recovered nor returned to work, but were optimistic about finding a new career. (4) The Stuck, who had not recovered nor returned to work, but in contrast to the previous group, were passive and hesitant about returning to work. (5) The Pension-oriented, who were demotivated to return to work and had complex problems. The interviewees regarded the health care, rehabilitation and benefit systems as too complicated and frag¬mented. The TOIKE Work Ability Centre had provided useful counselling to some of the respondents, but unfortunately, most of the interviewees had not contacted the TOIKE Centre due to a lack of knowledge or understanding of the purpose of the pilot service. Conclusions: Individuals with lowered work ability are a heterogeneous group and therefore their service needs vary. Identifying distinctive groups among the partially disabled, as done in this study, and considering their own perceptions and needs in planning and promoting services may prove useful in designing interventions to support returning to work. This study focused on individuals with MSDs, but the five categories could possibly be applicable to other disease groups as well. Therefore, it would be important to study the perceptions of individuals whose work ability is lowered for other reasons, such as mental health disorders, for example