BackgroundThe UK Government's objective to reduce the rate of incapacity benefit receipt has been addressed with large-scale welfare reform, permeated with rhetoric around recipients' motivation. However, there is limited evidence about what determines motivation for employment or what distinguishes people who are motivated from those who are unmotivated; we aimed to explore this question to highlight areas to best direct support. MethodsParticipants were recruited from general practices with high levels of incapacity benefit receipt in Glasgow, UK. All long-term (>2 years) recipients of this benefit were identified from patient lists, and recruitment aimed to provide a diverse sample (eg, in terms of health condition, age, length of benefit receipt). Semi-structured interviews were conducted with 17 recipients and digitally recorded. Framework analysis was used as a systematic and transparent thematic-analysis method, with matrices produced to compare the occurrence of themes across participants. Themes were identified from transcripts and then refined. Ethics approval was obtained from NHS West of Scotland Research Ethics Committee (10/S0709/46). FindingsParticipants' preference was to be employed. However, motivation for employment was multifaceted; it was not based solely on preference, but involved opportunity, capacity, social circumstance, work-role centrality, and existence of alternative options. Many participants had a complex build-up of health and social issues throughout their lives that culminated in their current situation and affected their motivation. Others had seemingly more straightforward situations in that their health stopped them from working. Nonetheless, all had multiple interacting barriers to return to paid employment, and motivation was affected by wider labour-market and social-context issues. InterpretationStipulations placed on incapacity benefit recipients fail to recognise the range of employment barriers they face. Previous research has considered motivation as an individual issue; here we argue that motivation can be a problem, but largely beyond individual control. Policies to tackle motivation should not solely be aimed at individual incapacity benefit recipients: the improvement of motivation for employment requires an improvement in the capacity, opportunity, and social context required to become employed. A diverse sample was achieved in terms of participant characteristics. Glasgow has poor health compared with wider UK populations, though barriers to employment were similar when compared with other studies; broad themes are likely to be comparable across populations. FundingThe Chief Scientist Office of the Scottish Government (grant number: DTF/09/14) funded the research as part of KS's doctoral training.
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