Application of the Theoretical Domains Framework and the Behaviour Change Wheel to Understand Physicians\u2019 Behaviors and Behavior Change in Using Temporary Work Modifications for Return to Work: A Qualitative Study

Ritva Horppu,K P Martimo,E Maceachen,E Viikari-Juntura,T Lallukka

doi:10.1007/s10926-017-9706-1

Abstract

Purpose Applying the theoretical domains framework (TDF) and the Behaviour Change Wheel (BCW) to understand physicians’ behaviors and behavior change in using temporary work modifications (TWMs) for return to work (RTW). Methods Interviews and focus group discussions were conducted with 15 occupational physicians (OPs). Responses were coded using the TDF and the BCW. Results Key behaviors related to applying TWMs were initiating the process with the employee, making recommendations to the workplace, and following up the process. OP behaviors were influenced by several factors related to personal capability and motivation, and opportunities provided by the physical and social environment. Capability comprised relevant knowledge and skills related to applying TWMs, remembering to initiate TWMS and monitor the process, and being accustomed to reflective practice. Opportunity comprised physical resources (e.g., time, predefined procedures, and availability of modified work at companies), and social pressure from stakeholders. Motivation comprised conceptions of a proper OP role, confidence to carry out TWMs, personal RTW-related goals, beliefs about the outcomes of one’s actions, feedback received from earlier cases, and feelings related to applying TWMs. OPs’ perceived means to target these identified factors were linked to the following BCW intervention functions: education, training, persuasion, environmental restructuring, and enablement. The results suggest that at least these functions should be considered when designing future interventions. Conclusions Our study illustrates how theoretical frameworks TDF and BCW can be utilized in a RTW context to understand which determinants of physicians’ behavior need to be targeted, and how, to promote desired behaviors.

Highlights

Activities are beneficial for recovery, especially from musculoskeletal and mental disorders [1]
In our earlier qualitative study, occupational physicians considered staying at work (SAW)/returning to work (RTW) with temporary work modifications (TWMs) to a large extent beneficial for employees and other stakeholders if the RTW situation and context are taken into consideration [6]
All 15 participants were accustomed to using work modifications to support RTW

Summary

Introduction

Activities (incl. appropriate work) are beneficial for recovery, especially from musculoskeletal and mental disorders [1]. In our earlier qualitative study, occupational physicians considered SAW/RTW with temporary work modifications (TWMs) to a large extent beneficial for employees and other stakeholders if the RTW situation and context are taken into consideration [6]. Previous studies have identified various barriers to and enablers of using TWMs, as reported by physicians using the fit note [7,8,9,10] or supporting RTW more generally [11,12,13,14]. Physicians have described challenges related to personal knowledge, skills, and conceptions of a physician’s role, as well as to environmental factors, such as hesitancy or negative attitudes of various workplace stakeholders, and scarcity of clear RTW procedures at workplaces, such as lack of accommodated work; and the level of cooperation with all parties. Not being involved in the RTW process from the beginning and not having easy access to employees’ health status have been reported as barriers of applying TWMs [15]

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Results

Conclusion