A Mega-Ethnography of Qualitative Meta-Syntheses on Return to Work in People with Chronic Health Conditions

Abstract

Purpose The aim of this study was to synthesize the findings of qualitative meta-syntheses (QMS) on return to work (RTW) of people with different chronic illnesses and to develop a generic RTW model that can provide advice on how to improve RTW interventions and strategies.

Methods We conducted a systematic literature search in PubMed, Epistemonikos, CENTRAL, and PsycARTICLES to find relevant QMS, published in English or German between 2000 and 2021, and adapted the meta-ethnographic approach of Noblit and Hare to synthesize their findings.

Results Nineteen QMS (five focusing on musculoskeletal disorders or chronic pain, four on acquired or traumatic brain injuries, four on cancer, two on mental disorders, one on spinal cord injury, and three on mixed samples) met our inclusion criteria for the meta-ethnographic synthesis. Through systematic comparison and reciprocal translation of the single QMS findings, we could identify a set of key cross-cutting themes/concepts, which formed the basis for four RTW principles and a generic RTW model.

Conclusions RTW is a multifactorial and highly interactive multistakeholder process, embedded in an individual‘s life and working history, as well as in a determined social and societal context. It runs parallel and interdependently to the process of coping with the disease and realigning one’s own identity, thus emphasizing the significance of RTW for the person. Besides symptoms and consequences of the disease, individual coping strategies, and RTW motivation, the course and success of RTW are strongly affected by the adaptability of the person’s working environment and the social support in their private and working life. Thus, RTW is not only a problem of the individual, but also a matter of the social environment, especially the workplace, requiring a holistic, person-centered, and systemic approach, coordinated by a designated body, which considers the interests of all actors involved in the RTW process.

Zusammenfassung

Einleitung Um zusätzlich zu quantitativen Meta-Analysen und über einzelne Erkrankungsgruppen hinaus übergreifende Erkenntnisse zur beruflichen Wiedereingliederung (Return to Work, RTW) zu gewinnen, wurde eine Zusammenstellung der Ergebnisse qualitativer Meta-Synthesen (QMS) vorgenommen. Ziel war die Erarbeitung eines generischen RTW-Modells sowie daraus resultierender Empfehlungen für die Rehabilitationspraxis.

Methoden Grundlage bildete eine systematische Literaturrecherche in PubMED, Epistemonikos, CENTRAL und PsycARTICLES zur Identifizierung thematisch einschlägiger QMS, die zwischen 2000 und 2021 veröffentlicht wurden. Die Synthese erfolgte auf der Basis des Ansatzes von Noblit und Hare.

Ergebnisse 19 QMS (muskuloskelettale Erkrankungen/chronischer Schmerz: 5, erworbene Hirnschädigung: 4, psychische Erkrankungen: 2, Querschnittlähmung: 1 und gemischte Gruppen: 3) wurden final in die Analyse einbezogen. Im systematischen Vergleich und der wechselseitigen Übersetzung der einzelnen Ergebnisse konnten wir eine Reihe übergreifender Themen/Konzepte identifizieren, die die Grundlage für 4 RTW-Prinzipien und ein generisches RTW-Modell bildeten.

Schlussfolgerungen Der RTW ist als multifaktorieller und hochgradig interaktiver Prozess mit vielen Beteiligten anzusehen, der in eine individuelle Lebens- und Arbeitsgeschichte sowie in einen sozialen und gesellschaftlichen Kontext eingebettet ist. Er verläuft parallel zu und in Wechselwirkung mit dem Prozess der Krankheitsbewältigung und der Neuausrichtung der eigenen Identität. Neben den Symptomen und Folgen der Krankheit, den individuellen Bewältigungsstrategien und der Motivation zur Wiedereingliederung werden der Verlauf und der Erfolg der Wiedereingliederung stark von der Anpassungsfähigkeit des Arbeitsumfelds und der sozialen Unterstützung im privaten und im Arbeitsleben beeinflusst. Der RTW ist kein Problem des Einzelnen, sondern immer auch eine Angelegenheit des sozialen Gefüges und erfordert einen ganzheitlichen, personenzentrierten und systemischen Ansatz sowie eine alle Beteiligten und deren Interessen koordinierende Instanz.

Key words

review - meta-synthesis - return to work - mega-ethnography - qualitative evidence synthesis - chronic illnesses

Schlüsselwörter

Review - Meta-Synthese - Return to Work - Mega-Ethnografie - Qualitative Evidenzsynthese - chronische Erkrankungen

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