Personal and social factors impact return to work after ill-health

Support from managers and colleagues, as well as a positive attitude, are most likely to enable a more long-term return to work for employees after a sickness absence, according to a new review of research led by the University of East Anglia (UEA). The review evaluated the impact of personal and social factors on sustainable return to work after ill-health due to musculoskeletal disorders, such as joint and back pain, and common mental health conditions, for example stress, depression or anxiety.

It also compared the effects of these factors across the two types of conditions, which are recognised as the most common causes of sickness absence in developed countries.

Personal and social factors were found to play a role in enabling sustainable return to work after ill health. However, sustainable return to work does not appear to be the result of a single factor. Instead, it seems to be influenced by a combination of multiple factors.

Researchers from UEA’s Norwich Business School and Uppsala University in Sweden found the most consistent evidence for achieving sustainable return to work was for support from line managers or supervisors and co-workers, employees having a positive attitude and high self-efficacy – their belief in their capabilities to achieve a goal or outcome – being younger and having higher levels of education.

The review examined evidence from 79 previous studies conducted between 1989 and 2017. Its findings are published in the Journal of Occupational Rehabilitation.

For the purposes of the review, sustainable return to work was defined as a stable full-time or part-time return to work to either the original or a modified job for a period of at least three months, without relapse or sickness absence re-occurrence.

A culture of support

Lead author Abasiama Etuknwa, a postgraduate researcher at UEA, said: “These findings will help us understand what factors may either bring about or hinder a sustainable return to work. The relationship between the social environment and personal factors like attitudes and self-efficacy appears to impact positively on maintainable return to work outcomes. Promoting a culture of support at the workplace is essential, a culture that makes returning workers feel valued, worthy and not necessarily blamed for absence, as the former would improve work attitudes and ease the transition back to work.”

The economic cost of sickness absence is growing yearly. Extended sickness absence is associated with reduced probability of return to work, which becomes costly for employers, increasing the urgency to help workers return early.

Co-author Kevin Daniels, professor of organisational behaviour at UEA, said: “To reduce costs related to sickness absence and reduce the risk of long-term disability associated with extended absence from work, there is a big need for a better understanding of the factors that either impede or facilitate a sustainable return to work for staff sick-listed with musculoskeletal and common mental health disorders.

“Previous studies have shown how poor quality jobs can cause ill-health. However, there is also strong evidence that good quality jobs, for example those that enable reasonable work-life balance, allow staff some say in how their work is done and have supportive managers, are an important component for a speedy recovery after ill-health episodes and are generally beneficial for physical and mental health.”

Other personal factors identified as impacting return to work included economic status/income, length of sickness absence, and job contract/security. There was no consistent evidence of whether gender affected sustainable return to work.

Social factors also included job crafting – employees redesigning their job task to fit their motives, strengths and passions – and its related practices, such as employee-initiated changes to their job or how work is done.

The authors say the review provides employers and policymakers with knowledge of the key factors that will help with implementing more effective return to work programmes.

“Existing return to work programmes need to encourage supportive interactions between leaders and co-workers and returning workers during the process, especially as this could have a direct effect on sustainable return to work, as well as an indirect effect through enhanced returners’ attitudes towards work and self-efficacy,” said Miss Etuknwa. “Although return to work takes place within a complex system involving employing organisations and the healthcare system, given the consistent evidence of the role line managers play, we recommend that policymakers consider ways to provide guidance for employers.”

This guidance could: outline the supportive role of line managers and other key workplace professionals, for example human resources professionals and occupational health providers, during the return to work process; train these professionals on the return to work process and how to effectively manage and support returning workers; and outline ways to assist line managers in providing necessary support.