What hinders me returning to work? Sick listed employees own stories

BACKGROUND: Long-term sick leave can have extensive consequences ranging from the micro- to the macro-level and poses a challenge globally. Low educational level is negatively associated with return to work (RTW) across disorders. Still, there is limited research into which barriers for RTW this group experience. The aim of this study was to identify self-perceived barriers for RTW among employees on long-term sick leave with low educational level. METHODS: We used material from the NOW WHAT RTW Barrier study, a large-scale interview study with long-term sick listed employees from Norway. Employees on long-term sick leave with low educational level (defined here as primary and secondary school level) were included in the current study (N = 122). Using the World Health Organization's classification system of function, disability, and health (ICF), the data was investigated with a qualitative and quantitative content analytical approach. RESULTS: We identified N = 1,942 meaning units describing barriers for RTW. The frequency of coded barriers was highest for the ICF domain Body Function n = 552(28%, min 0, max 15, mean=4,5), followed by Environmental factors n = 411(21%, min 0, max 17, mean=3,4), Activity limitations n = 352(18%, min 0, max 14, mean=2,9), Personal factors n = 323(17%, min 0, max 16, mean=2,6), and lowest for Participation restrictions n = 151(8%, min 0, max 5, mean=1,2) and Body structure n = 146(8%, min 0, max 9, mean=1,2). The most prevalent ICF sub-domains were Mental functions n = 229(42% of the Body Functions barriers, min 0, max 11, mean=1,9) and Services, systems, and policies n = 257(63% of the Environmental barriers, min 0, max 16, mean=2.1). CONCLUSIONS: Employees on long-term sick leave with low educational level describe a wide range of barriers to RTW. In addition to functional barriers, identifying environmental barriers are important to increase insight and understanding of potential determinants of absence from work for this group. KEY MESSAGES: • Identifying RTW barriers related to functional and environmental factors can increase insight and understanding of absence from work for employees on long-term sick leave with low educational level. • Insight into self-perceived RTW barriers for long-term sick listed with low educational level can contribute to more effective and sustainable RTW processes and further development of RTW services.