Fear of (re)injury and return to work following compensable injury: qualitative insights from key stakeholders in Victoria, Australia

Abstract

BackgroundReturn to work (RTW) is important for recovery post-injury. Fear of (re)injury is a strong predictor of delayed RTW, and therefore much attention has been given to addressing injured workers’ fear beliefs. However, RTW is a socially-negotiated process and it may be important to consider the wider social context of the injured worker, including the beliefs of the key people involved in their RTW journey.MethodsThis paper involves data collected as part of a wider study in which semi-structured interviews explored RTW from the perspectives of 93 key stakeholders: injured workers, GPs, employers and insurance case managers in Victoria, Australia. Inductive analysis of interview transcripts identified fear of (re)injury as a salient theme across all stakeholder groups. This presented an opportunity to analyse how the wider social context of the injured worker may influence fear and avoidance behaviour. Two co-authors performed inductive analysis of the theme ‘fear of (re)injury’. Codes identified in the data were grouped into five categories. Between and within category analysis revealed three themes describing the contextual factors that may influence fear avoidance and RTW behaviour.ResultsTheme one described how injured workers engaged in a process of weighing up the risk of (re)injury in the workplace against the perceived benefits of RTW. Theme two described how workplace factors could influence an injured workers’ perception of the risk of (re)injury in the workplace, including confidence that the source of the injury had been addressed, the availability and suitability of alternative duties. Theme three described other stakeholders’ reluctance to accept injured workers back at work because of the fear that they might reinjure themselves.ConclusionsOur findings illustrate the need for a contextualised perspective of fear avoidance and RTW behaviour that includes the beliefs of other important people surrounding the injured worker (e.g. employers, family members, GPs). Existing models of health behaviour such as The Health Beliefs Model may provide useful frameworks for interventions targeting the affective, cognitive, social, organisational and policy factors that can influence fear avoidance or facilitate RTW following injury.

The Influence of Social Support and Social Integration Factors on Return to Work Outcomes for Individuals with Work-Related Injuries: A Systematic Review

“…As the measurement of RTW varies substantially between studies, all RTW status (e.g., partial, full, or sustained RTW [SRTW]) and RTW timing (e.g., duration of absence/compensation) outcomes were included. Table 1 provides details of how RTW was assessed in each study, including the length of follow-up from time of injury where available [28–50].…”

“…A lack of trust in the employer or supervisor was a barrier to RTW process, especially in terms of workers experiencing doubts that their employer would act in their best interests [28, 29, 32]. These findings were from studies of medium quality.…”

Supporting people experiencing a burn injury to return to work or meaningful activity: Qualitative systematic review and thematic synthesis

“…Fear of re-injury was highlighted in the present review as a catalyst for anxiety and the potential to delay RTW. This fear has been reported to be one of the strongest predictors of delayed RTW (Bunzli et al, 2017). Emotional support has been highlighted within burns literature as an effective coping strategy (Kildal et al, 2005).…”

Social prescribing as an intervention for people with work-related injuries and psychosocial difficulties in Australia

“…Workplace features, such as feeling effective and supported in one's work role, and having a strong workplace culture (that does not include bullying, excessive performance expectations, or unsafe practices) also contribute to injury prevention and recovery [12] . Aspects that may reduce motivation to return to work after injury include being of older age, having younger children, experiencing family problems, and having a perception of the workplace as dangerous or of the employer as being unable or unwilling to allow for work role modifications [13] . In one large retrospective analysis of occupational rehabilitation users in Victoria, Australia, the factor that most predicted lower likelihood of returning to work was psychiatric treatment, but better outcomes were achieved by those in this group if they engaged in services that assisted in finding new employment rather than returning to their previous workplace [14] .…”