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.Electronic supplementary materialThe online version of this article (doi:10.1007/s10926-017-9706-1) contains supplementary material, which is available to authorized users.

The present study investigated beginning kindergarten student teachers' mental models of attachment as a part of their practical knowledge about caregiving. Mental models of attachment (i.e. how students construct their own attachment-related childhood experiences and relationships from their current perspective) were assessed with an Adult Attachment Interview. The participants were 82 female first-year students in the University of Helsinki. Forty-four per cent of the students were classified as dismissive of attachment, 43% as secure/autonomous, and 13% as preoccupied. The study also investigated student teachers' motives for entering kindergarten teacher education, and the possible relationship between students' mental models of attachment and their motives for entering the field. Participants' attachment status was significantly associated with their career preference, and the expression and complexity of their motives. Students with a secure/autonomous mental model of attachment were the most certain students concerning career choice, and they were the most likely to express both child-centred and self-centred motives for entering the education.

This study examined whether attachment styles, constructed in close relationships, are related to applicants' perceptions and emotions in a substantially different relationship with evaluators in a college entrance examination. The findings suggest that secure and fearful styles may consist of somewhat stable interpersonal orientations that are evident across relationships. Fearful attachment was related to lower anticipatory challenge appraisal, more negative emotional reactions, and a less positive view of evaluators during the examination. Secure attachment was related to more positive views of self and evaluators. Interview boards assessed more fearful applicants as less suitable, and more secure applicants as more suitable for kindergarten teacher education. The only significant findings for preoccupied and dismissing attachment styles were obtained in the context of close relationships.

Previous research indicates that work modifications can effectively enhance return to work (RTW) at an early stage of work disability. We aimed to examine how occupational physicians (OPs) reason about recommending early return to work (RTW) with work modifications. Pre-defined propositions regarding the use of work modifications in promoting early RTW were discussed in four focus groups with altogether 11 Finnish OPs. Discussions were audio recorded, and the transcribed data were analyzed using qualitative content analysis. Five different rationales for supporting early RTW were identified: to manage medical conditions, to enhance employee well-being, to help workplace stakeholders, to reduce costs to society, and to enhance OP’s own professional fulfillment. However, OPs identified situations and conditions in which early RTW may not be suitable. In addition, there were differences between the OPs in the interpretation of the rationales, suggesting variation in clinical practice. In conclusion, encouraging early RTW with work modifications was perceived by OPs as a meaningful task and, to a large extent, beneficial for employees and several stakeholders. However, this practice was not accepted without consideration to the RTW situation and context. If early RTW and work modifications are to be promoted, OPs should be offered education that addresses their views regarding this practice.

IntroductionPrevious research suggests that work with a suitable workload may promote health and work retention in people with disability. This study will examine whether temporary work modifications at the early stage of work disability are effective in enhancing return to work (RTW) or staying at work among workers with musculoskeletal or depressive symptoms.Methods and analysisA single-centre controlled trial with modified stepped wedge design will be carried out in eight enterprises and their occupational health services (OHSs) in nine cities in Finland. Patients seeking medical advice due to musculoskeletal pain (≥4 on a scale from 0–10) or depressive symptoms (≥1 positive response to 2 screening questions) and fulfilling other inclusion criteria are eligible. The study involves an educational intervention among occupational physicians to enhance the initiation of work modifications. Primary outcomes are sustained RTW (≥4 weeks at work without a new sickness absence (SA)) and the total number of SA days during a 12-month follow-up. Secondary outcomes are intensity of musculoskeletal pain (scale 0–10), pain interference with work or sleep (scale 0–10) and severity of depressive symptoms (Patient Health Questionnaire, PHQ-9), inquired via online questionnaires at baseline and 3, 6, 9 and 12 months after recruitment. Information on SA days will be collected from the medical records of the OHSs over 12 months, before and after recruitment.The findings will give new information about the possibilities of training physicians to initiate work modifications and their effects on RTW in employees with work disability due to musculoskeletal pain or depressive symptoms.Ethics and disseminationThe Coordinating Ethics Committee of Hospital District of Helsinki and Uusimaa has granted approval for this study. The results will be published in peer-reviewed journals.Trial registration numberISRCTN74743666.