Living with a long-term health condition and seeking paid work: qualitative systematic review and thematic synthesis

Abstract

Purpose: An interplay of complex issues influence opportunities to gain paid work for people living with long-term conditions, but there are patterns that traverse the various contexts. Synthesising findings across qualitative studies can inform vocational rehabilitation approaches. Methods: Public consultation and PRISMA guidelines were used to develop a protocol and comprehensive search strategy. Seven databases were searched and results screened against inclusion criteria. Included studies investigated either lived experiences of gaining paid work while living with a long-term condition or the socio-cultural factors affecting opportunities for paid work. Findings were extracted from included studies and then analysed using thematic synthesis. Results: Sixty-two studies met inclusion criteria. Identified themes demonstrate that people living with long-term conditions need access to support through the different stages of gaining paid work. This can include considering the benefits and risks of having paid work and negotiating needs in the workplace prior to and during employment. Positive experiences for workers and employers were influential in changing attitudes about the work-ability of people living with long-term conditions. Conclusion: Findings emphasise the interplay between socio-cultural norms and the constraints experienced in trying to gain work. Appropriately targeted support can unlock possibilities that are otherwise hindered by these norms. ä IMPLICATIONS FOR REHABILITATIONPositive experiences of paid work for people living with long-term conditions and those who employ them are important for stimulating future opportunities. "Informal" or alternative routes into paid work are experienced as more successful in contending with discrimination. Job seekers living with long-term conditions need access to pre-placement advocacy, support to negotiate work-related needs, and support to negotiate difficulties that arise in the job. Vocational rehabilitation initiatives need to have good collaboration with other health services to ensure consistent messages about seeking and managing work.

Returning to work or working on one’s rehabilitation: Social identities invoked by impaired workers and professionals in health care and employment services

“…When Ben failed, the explanation was the co‐owned company in which financial exposure required the extraordinary labour (and joy) of its partners. This pattern aligns with previous studies highlighting the importance of workplace factors and the response of employers, supervisors and human resource staff for accommodating workers with health problems and impairments (Abma et al, 2013; Cancelliere et al, 2016; Donker‐Cools et al, 2018; Fadyl et al, 2020; Kenny, 1998; MacEachen et al, 2006). In seeing workplace factors (related to own impairments) as decisive, the injured individuals’ stories also demonstrate the belief that it is beyond the scope of the professionals’ work to intervene in workplace factors.…”

“…Many people at the margins of the labour market struggle with long‐term illness or impairment (OECD, 2010). Therefore, employment services must be provided to them in conjunction with health care, social services and rehabilitation (Fadyl et al, 2020; Heidenreich & Aurich‐Beerheide, 2014). Avoiding job loss, providing accommodations and support in the workplace, supporting a person’s active participation in their rehabilitation processes, organising flexible and coordinated services and operating across institutional and organisational boundaries are all essential to the return‐to‐work process (Andersen et al, 2012; Cancelliere et al, 2016; Liaset & Lorås, 2016).…”

“…This research demonstrates that return‐to‐work processes are influenced by the perceptions of health, work and workplaces held by clients as well as professionals. How clients understand their illness or injury and its impact on their return‐to‐work process has been an under‐researched topic and is only now gaining more attention (Fadyl et al, 2020; Fadyl & McPherson, 2008; Hoving et al, 2010).…”

Vocational interventions to help adults with long-term health conditions or disabilities gain and maintain paid work: an overview of systematic reviews

“…In order to test this assumption, and to fill in some of these possible gaps in the evidence subsequent to this overview, we undertook three additional systematic reviews on vocational interventions for people living with: (1) mild to moderate mental health conditions, (2) amputation and (3) progressive neurological conditions, and a fourth systematic review on vocational intervention for Indigenous people with long-term conditions living in a postcolonial context. 53 However, this revealed no further evidence relevant to this overview, except in the case of research involving people with mild to moderate mental health conditions, where we found low-quality evidence supporting the use of modified IPS approaches to help people gain paid work (RR 1.70; 95% CI 1.23 to 2.34). 54 There is therefore urgent need for further well-conduct experimental trials of vocational interventions for people living with long-term health conditions or disability.…”

“…55 We also recommend that when undertaking systematic reviews and studies of vocational intervention that a clear distinction is made between studies involving people who are returning to prior employment and those involving people who are unemployed and seeking new employment, since these two situations comprise quite different needs and challenges. 56 Regarding the quality of this overview, we conducted systematic searches based on a comprehensive search strategy. We have a high degree of confidence that it is unlikely that we missed important systematic reviews that may have substantively changed the conclusions of this overview.…”