Abstract This qualitative study explored the experiences of employed women with breast cancer. The narrative approach using Frank’s (1995) illness types and the feminist perspective were applied in looking at the women’s diversity of experiences and meanings. Purposive sampling was used to recruit women aged 30-49 (n=8) who continued working during treatment and after treatment ended. Face to face, semi-structured interviews were conducted. The findings discovered that all the women got reasonable accommodations; work environment was supportive; and the majority was successful in returning to work despite treatment challenges. Two separated participants reported being locked into job because of medical insurance and discrimination. Concerns identified were: More support from health care professionals, information, dietary, counselling and the need to be listened to. This study can help social workers and other health care professionals to review their roles in supporting women who return to work and in managing the cancer experience.

A critical task of social policy in most Western welfare states during recent decades has consisted of reducing the economic burden on society due to sick leave, by stimulating participation in the labour market. Many jurisdictions have introduced activation policies, based on the premise that work “per se” has a therapeutic effect on sick-listed workers. People are expected to be “active”, rather than “passive”, recipients of financial benefits. However, there is limited knowledge of how activation policies focusing on return to work (RTW) are carried out in local practice. Against this background, the overall aim of this thesis is to study the local practice of activation policies by analysing how they are received, implemented and experienced by welfare state organizations, employers and sick-listed workers. The analysis has been influenced by theories concerning organization fields, individualization, street-level bureaucracy and organizational governance. In this thesis, the overall aim is investigated in four interrelated papers. In Paper I, the aim is to analyse the perspectives of stakeholders (i.e. welfare state actors and employers) on work ability by studying multistakeholder meetings. Paper II sheds light on activation policy, focusing on early RTW in the context of modern working conditions; the aim is to analyse RTW practice in local workplace contexts, in relation to Swedish early-RTW policy. The third paper focuses on employers, with the aim of analysing their role and activities regarding RTW, in local workplace practice. In Paper IV, the aim is to analyse sick-listed workers’ experiences of the sickness insurance system in their contact with the Swedish Social Insurance Agency (SSIA) and their front-line staff. The empirical material comprises two empirical studies: 1) audio-recorded multi-stakeholder meetings from regular practice (n=9) and 2) semi-structured interviews with sick-listed workers and their supervisors in 18 workplaces (n=36). The analyses of the material have been performed in accordance with the principles of qualitative content analysis. Main findings of the papers reflect strong organizational boundaries in the implementation process of activation policies. Welfare state actors and employers appear to be governed by their own organizational logics and interests, so the actors involved fail to take a holistic view of sick-listed workers and do not share a common social responsibility for individuals’ RTW. This thesis illustrates how current activation policies focusing on RTW are based on a rather idealized image of the standard workplace. There is an explicit or implicit assumption that employers and work organizations are able to welcome sick-listed workers back to work in a healthy way. However, the intensity of modern working life leaves limited room for accommodating people with reduced work ability, who are not considered to have a business value to the workplace. In several cases, findings indicate that the SSIA’s focus on activation and early RTW clashes with the financially oriented perspective of employers. Economic considerations regarding their business take precedence over legal and ethical considerations, and employers have difficulty taking social responsibility for RTW. Sick-listed workers are encouraged to adjust to new workplace settings and environments to meet the demands of the workplace, and, if RTW is not possible, to the demands of the labour market. The findings also show that sick-listed workers experience that contacts with the SSIA are ‘standardized’; i.e., they perceive that the officials are loyal  to demands in their organizations rather than being involved actors who support workers’ individual needs. Sick-listed workers clearly experience that measures in Swedish activation policies have a strong focus on demanding aspects (financial work incentives) and less on enabling aspects (investments in skills). Overall, this thesis illustrates an emerging social climate where sick-listed workers are positioned as active agents who must take responsibility for their sick leave and their RTW process. In a Swedish context, RTW is a matter of activating the sick-listed rather than activating the workplace.

Regeringen vill lägga mer vikt på att stärka möjligheten till kultur och social delaktighet. De belyser vikten av att skapa trygghet och att minska isolering inom grupper som till exempel långtidssjukskrivna och långtidsarbetslösa. Kulturaktiviteter som konst, film, musik och teater har bevisats ha en positiv effekt på hälsan genom bland annat ökad social funktion, ökad livskraft och ökad fysisk hälsa. Det avser både att delta i samt att uppleva utan att delta i kulturen. Syftet med denna studie var att undersöka om kulturaktiviteter kan påvisa en skillnad i återgång till arbete och psykisk ohälsa hos långtidssjukskrivna personer med psykisk ohälsa, samt undersöka vilken påverkan egna förväntningar har på återgång till arbete. Det insamlade materialet kom från enkätdata ur projektet Kultur och hälsa, genomförd av landstingets enhet Kompetenscentrum för hälsa i Västerås stad. Resultatet visade att andelen som åter var i arbete efter deltagande i kulturaktiviteter hade ökat och den psykiska hälsan hade förbättrats, men inga statistiska samband kan fastställas i denna studie. Mer forskning behövs inom området kultur som hjälp för återgång till arbete efter långtidssjukskrivning. / The government wants to put more emphasis on strengthening the ability to culture and social participation. They highlight the need to provide security and to reduce the isolation of groups such as long-term sickness and unemployed. Cultural activities such as art, film, music and theater have proven to have a positive effect on health by, improved social functioning, increased vitality and physical health. It refers both to participation in and to experience without participating in culture. The aim of this study was to investigate whether cultural activities may effect in a difference in the return to work and mental illness among long-term sick people with mental health problems, and investigate the impact of their own expectations on return to work. The collected material was taken from the project Culture and Health, made ​​by Department of public health, Västmanland County council in Västerås. The results showed that the proportion of who was back in work after participating in cultural activities had increased and mental health had improved, but no statistical link could be established in this study. More research is needed in the area about if culture help people to return to work after long term sickness.

Aim: The overall aim of this thesis was to study health-related quality of life (HRQoL) and return to work in the first 3 years following a breast cancer diagnosis, and to identify clinical and contextual factors associated with these outcomes. Method: The four studies were part of a population-based cohort study including women identified in the Breast Cancer Quality Register in central Sweden. Of 1,573 women asked to participate, 69% (n=1,093) responded to a baseline questionnaire, 62% (n=977) responded at the 1st follow-up and 54% (n=856) participated at the 2nd follow-up (mean time 4, 16 and 38 months post-diagnosis, respectively). Studies II and IV only included women aged <63 years at diagnosis. In Study IV, each woman was individually matched to five breast-cancer-free controls. Questionnaire data on HRQoL, socio-demographics and work-related variables were combined with clinical register, normative and social insurance data. Main findings: Study I: Women with breast cancer, particularly women aged <50 years, experienced poorer HRQoL at baseline than normative data. Chemotherapy, lack of social support, sick leave and a poor financial situation were associated with poorer HRQoL. Study II: Compared with pre-diagnosis working time, 72% of participating women reported no change, 2% had increased their working time, 15% reported a decrease in working time and 11% did not work at the 1st follow-up. Chemotherapy, cancer-related work limitations and less value attached to work increased the odds of job discontinuation/decreased working time. Study III: During the 3 years post-diagnosis, HRQoL generally improved. Less consistent improvements were found among women on sick leave/disability pension pre-diagnosis and women reporting job discontinuation/decreased working time post-diagnosis. Study IV: The proportion of women with breast cancer on sick leave steadily decreased during the 3 years post-diagnosis, but they were more likely to be on sick leave than the controls. Chemotherapy, fatigue and pre-diagnosis sick days predicted sickness absence during the 2nd and 3rd year post-diagnosis. Conclusions: Most women with breast cancer gradually recover, but there are subgroups of women who may be particularly vulnerable. In a clinical setting, increased attention should be directed towards women undergoing chemotherapy, young women, women on sick leave/disability pension pre-diagnosis and women who do not return to work to the same extent as pre-diagnosis.

Abstract This qualitative study explored the experiences of employed women with breast cancer. The narrative approach using Frank’s (1995) illness types and the feminist perspective were applied in looking at the women’s diversity of experiences and meanings. Purposive sampling was used to recruit women aged 30-49 (n=8) who continued working during treatment and after treatment ended. Face to face, semi-structured interviews were conducted. The findings discovered that all the women got reasonable accommodations; work environment was supportive; and the majority was successful in returning to work despite treatment challenges. Two separated participants reported being locked into job because of medical insurance and discrimination. Concerns identified were: More support from health care professionals, information, dietary, counselling and the need to be listened to. This study can help social workers and other health care professionals to review their roles in supporting women who return to work and in managing the cancer experience.

Abstract Challenges, problems, and conflicts can be the seeds of growth, or the seeds of destruction. It seems worthwhile to develop skills for addressing and resolving life challenges in ways that promote growth. Problem solving skills are a component of any performance challenge whether athletic, academic, professional, or personal. However, the cognitive and physiological resources and processes associated with problem solving have the potential to act in ways that both enhance and inhibit effective problem solving and performance outcomes. The threat appraisal mechanism, the subconscious process of evaluating whether a challenge poses a threat, is designed to preserve the individual but can also work to interfere with an individual’s capacity for creative problem solving. Focus, a process capable of galvanizing an individual’s attention and energies toward a singular purpose, can erode performance just as powerfully by drawing energies away from performance goals. Insight into the interactions and interdependencies of underlying cognitive and physiological mechanisms and principles comprising the problem solving process would better inform the design of facilitative performance interventions for a variety of realms including business, academic, athletic, and interpersonal. The following experimental and quasi-experimental field study explored the relationship between cognitive appraisal, attentional focus, problem solving, and goal attainment. The research examined the influence that threat focus, assumption focus, goal focus and ‘integrated’ focus had upon coping strategies, cognitive stress appraisal, and performance outcome on problem solving tasks. Shifts in focus were achieved using questions designed to direct thinking. Qualitative and quantitative analyses were conducted in the form of three separate but interrelated experiments. The first experiment compared the impact of three focusing interventions on problem solving rate and approach on a variety of insight problems. The second experiment evaluated a refined intervention against a control group on the same tasks. The final experiment applied the refined intervention within an organizational field setting and evaluated the impact of the intervention on problem solving approach and outcome when faced with challenges related to a workplace injury. Outcome was based upon correct solutions in the lab and sustainability of solutions in the field. Analysis of variance results demonstrated that the focusing intervention significantly and positively affected problem solving rate, outcome and approach in the lab and moderately and positively affected problem solving outcome and approach in a workplace setting. The research has implications for other individual, team and organizational settings suggesting that performance on a wide variety of problems may be improved by utilizing an integrated focus.

This thesis explores the occupational health and safety risks facing labour hire employees (also known as temporary agency workers) in the Australian state of Victoria. Three questions are considered. First do labour hire employees face greater risk of injury and disease than direct hire employees? Second, if so, which characteristics of labour hire employment contribute to a higher rate of injury? Third, what characteristics of labour hire employment reduce the likelihood of injured employees returning to work and being rehabilitated? The first question is answered by an aggregate analysis of data drawn from all workers' compensation claim files in Victoria between 1994/5 and 2000/1 contrasting the frequency of injury for both temporary agency employees and direct hire employees. Second a unique sub sample of individual investigated claim files was then examined to test employment factors that could account for the higher frequency of injury amongst agency workers. A third data source involved a survey and focus groups of temporary agency workers. This provided supplementary data on the work experiences of labour hire employees. A number of conclusions are drawn. Labour hire employees are more likely to be injured at work than their direct hire counterparts. Factors explaining this include economic pressures, disorganisation at the host workplace, and regulatory failure for agency employees. Several of these factors are uniquely related to the triangular nature of labour hire arrangements. Once injured at work, labour hire employees are especially disadvantaged relative to direct hire employees through the reluctance of many labour hire employers to offer further employment. This reduces the capacity of labour hire workers to return to meaningful employment. Regulatory failure stemming from both employment and occupational health and safety legislation underpins the greater likelihood of agency workers being injured at work and then dispensed with by employers. Until the uniqueness of their triangular relationship with employers and hosts is recognised through appropriate regulatory intervention, their greater occupational health and safety risks will not be overcome.

This critical hermeneutic study explored what it is like to re-enter the workforce following long-term forensic hospitalisation. An in-depth analysis of the phenomenon was completed, with the aim of evoking insights and developing understandings about the lived return-to-work experience. As this research was situated within the critical paradigm, the process of seeking, securing and sustaining employment was viewed in terms of power relationships, and through the multiple positionings of psychiatric disability, employment status and social capital.An unstructured interview process was used to explore the return-to-work experiences of eight purposefully selected informants with a history of mental illness and prior illness-related offending. They were living in the community and had returned to part or full-time employment, which they had sustained for at least six months. The gathered data was interpreted using hermeneutic analysis. This process revealed a number of themes, which were clustered into related groups, under eleven essential overarching themes. Freire's (1972) critical social theory was used to add critical depth to the findings.The findings reveal that returning to work exposes people who are affected by mental illness to an array of challenges and personal opportunities. People who have a forensic psychiatric history can encounter complex employment barriers related to stigma and misunderstanding. Therefore, the selected critical hermeneutic design provided a congruent framework with which to view the informants' quest to seek, secure and sustain employment. Despite significant obstacles, securing employment provides opportunities for individuals to test their skills while engaged in meaningful work activity. The acquisition of work skills can result in individuals' experiencing a strong sense of self-satisfaction. The experience of being bolstered by personal accomplishment often co-exists with, but is not necessarily negated by, difficulties that arise on-the-job.As there is scant reference to forensic rehabilitation within the mental health vocational literature, this study may be a timely contribution. It may also be used to add depth to the knowledge base within the field of mental health rehabilitation, in particular the specialised areas of forensic rehabilitation and vocational practise. Therefore, it may be a positive precursor to further discussion and analysis regarding work and education outcomes from the unique forensic psychiatric perspective.

The focus of this inquiry is “New Zealand small business employers’ perspectives of the important factors in return-to-work (RTW) of an employee following a musculoskeletal injury or an illness”. Whilst worldwide there is an increasing amount of attention focused on the RTW process in large organisations, there continues to be little understanding of this phenomenon in small businesses. I chose to use a social constructivist theoretical framework drawing on grounded theory methodology to construct some understanding of the employers’ perspectives of the RTW process. Eight small business employers from Auckland and Christchurch participated in this research. Data were gathered using semi-structured interviews. Constant comparative analysis, theoretical sampling and thematic analysis were used to construct two themes from the data. The findings showed that small business employers prefer informal organisational approaches, rely on close working relationships with their staff, are generally wary of bureaucracy and often must run their businesses with limited staff and financial resources. Having an employee off work for a prolonged period of time creates a sizable gap in the staff resources that keep the business running. The employer has responsibility to fill this gap while maintaining a productive business. In the absence of formal injury management practices an ad hoc approach was taken to the RTW process. A number of the employers felt undervalued by key stakeholders, such as doctors, treatment providers, Accident Compensation Corporation and in some cases RTW co-ordinators. Health and safety was a risk all employers appeared to take seriously whereas injury management information and support seemed less of a focus. This research suggests there may be little focus on injury management in small businesses by employers and, that employers perceive greater government emphasis on injury prevention. The extent and associated costs of work disability in small businesses is as yet unknown, but it is likely to be significant. How to support and encourage the uptake of injury management in small businesses in the long term warrants further investigation. Understanding that employers may well lack injury management expertise, experience and resources requires stakeholders to make specific effort with the employer, at the workplace, to facilitate the RTW process.

Philosophiae Doctor - PhD / Cardiovascular disease is amongst the top three leading causes of mortality in South Africa and the world. The effects of cardiovascular disease can be seen in limitations of function within all spheres of life, including work function. Cardiac rehabilitation programmes have been documented to improve functional abilities, but little is known about the return to work rate after cardiac rehabilitation. Access to cardiac rehabilitation programmes in the Western Cape is limited. This study aimed to determine the return to work rates and influencing factors after cardiac rehabilitation as well as to design an intervention programme that is accessible and could facilitate return to work for individuals with cardiovascular disease.