The overall aim of this thesis was to gain new knowledge of factors and interventions that improve work ability and return to work (RTW) among women on long-term sick leave from human service organizations (HSOs). The specific aims of the studies were: to evaluate the associations between the self-rated Work Ability Index (WAI) and Work Ability Score (WAS), and the relationship with prospective sick leave, symptoms, and health (Paper I); to investigate whether intervention with myofeedback training or intensive muscular strength training could decrease pain and increase work ability among women with neck pain (Paper II); to examine the associations between workplace rehabilitation and the combination of supportive conditions at work with work ability and RTW over time (Paper III); and to explore experiences, views, and strategies in the rehabilitation process for RTW (Paper IV). This thesis is based on a prospective cohort study (n=324) and a randomized controlled study (RCT) (n=60, participants with neck pain). Both quantitative and qualitative methods were used. The data collection consisted of questionnaires, laboratory-observed data, register-based data, and interviews. The results showed a very strong association between WAI and WAS, and results predicted future sick leave degree, health-related quality of life, vitality, neck pain, self-rated general health, self-rated mental health, behavioral stress, and current stress (Paper I). In the RCT (Paper II), individuals in the myofeedback intervention group increased their vitality and work ability over time and individuals in the intensive musculoskeletal strength training group increased their WAI, WAS, and mental health over time. WAI, WAS, and RTW increased over time among individuals provided with workplace rehabilitation and supportive conditions at work (Paper III) such as a sense of feeling welcome back at work, influence at work, possibilities for development, degree of freedom at work, meaning of work, quality of leadership, social support, sense of community, and work satisfaction. Women described (Paper IV) how they were striving to work and how they had different views, strategies, and approaches in the rehabilitation process for RTW. They expressed a desire to work, their goals for work, and their wishes for work. In the rehabilitation process for RTW they described their interaction with stakeholders as either controlling the interaction or struggling in the interaction. They described strategies to cope with RTW in terms of yo-yo (fluctuating) working: yo-yo working as a strategy or yo-yo working as a consequence. This thesis identifies factors of importance in improving work ability and RTW among women on long-term sick leave from HSOs. For women with neck pain, the intervention study showed feasibility of the intervention and demonstrated improved work ability and decreased pain (Paper II). The intensive muscular strength training program, which is easy for the individual to learn and perform at home, was associated with increased work ability. The results regarding rehabilitation highlight the importance of integrating workplace rehabilitation with supportive conditions at work to increase work ability and improve RTW (Paper III). Women expressed that they were striving to work and that they wanted to work (Paper IV). These women were “going in and out” of work participation (yo-yo working) as a way to handle the rehabilitation process. For assessing the status and progress of work ability among women on long-term sick leave, the single-question WAS may be used as a compliment to the full WAI as a simple indicator (Paper I). / <p>Akademisk avhandling som för avläggande av medicine doktorsexamen vid Sahlgrenska akademin, Göteborgs universitet, kommer att offentligen försvaras i hörsal Hamberger, Medicinaregatan 16 A, Göteborg, måndagen den 6 oktober 2014, klockan 09.00</p>

No description available.

Depuis un certain nombre d’années, se manifeste tout spécialement en Europe l’influence de la thématique de l’activation des dépenses sociales dites « passives ». Ce discours politique imprègne les systèmes nationaux et se diffuse sur le plan normatif, conduisant à de nouvelles articulations entre logiques de protection sociale classique (indemnisation ou aide sociale) et d’emploi (droit du travail). Ces politiques actives s’appuient sur les fondements traditionnels du modèle social-démocrate nordique et du modèle anglo-saxon. L’Union européenne a fait sienne la dynamique d’activation et lui a accordé une place centrale dans sa stratégie pour l’emploi et dans la Méthode Ouverte de Coordination en matière de protection sociale. Cette stratégie a produit un impact sur les systèmes nationaux. Cet impact a pu être mesuré aussi bien sur les systèmes béveridgiens que sur les systèmes bismarckiens, laissant apparaître une multiplicité des visages de l’activation selon les Etats-membres, mais selon une référence plus marquée soit à une approche libérale soit à une approche dite « universaliste » ou « prospective », d’amélioration des trajectoires professionnelles. Les transformations récentes des dispositifs français (indemnitaires ou assistantiels), basées sur une logique de conditionnalité des prestations, ont conduit à des bouleversements au sein de la protection sociale qui invitent à questionner les logiques juridiques sous-jacentes de ces mutations et à proposer une analyse critique de la portée d’un tel renouvellement du contrat social. / The influence of the theme of activating "passive" social expenditure has been evidenced over the last few years and especially in Europe. This political discourse has filtered into the national systems and has spread to legislation, leading to new links between the logic of classic social protection (compensatory technique or social assistance claimants) and employment (employment law). These active policies are based on traditional socio-democratic nordic models and the anglo-american model. The European Union has adopted the activation concept and given it central place in its employment strategy and through the Open Method of Coordination for social protection. This strategy has had an impact on the national systems. This impact may be measured in Beveridgian systems as well as in Bismarckian systems, that shows the different aspects of activation depending on the Member States but with a more distinct difference depending on a more liberal or universalist approach. The recent transformations in the French system (unemployment insurance benefits or social assistance schemes) based on the conditionality of social protection, have led to significant changes to social protection which raises the issue of the underlying legal logic of these changes and a critical analysis of the extent of such a renewal of the social contract.

No description available.

The purpose of this study was to examine the perceptions of working women when they announce their pregnancies, take maternity leave, transition back to work, and utilize flexible work policies. Using a qualitative methodology, transcripts of in-depth interviews were analyzed utilizing a life history approach. Key findings of the study are that women perceive more negative responses to the announcement of their pregnancies than positive ones. In terms of maternity and parental leave policies, all the participants had access to these benefits. Women found issues with financial adequacy, administration, and duration of these policies. Mothers found that financial support from the Canadian government was inadequate to allow them to take the full duration of the 52-week maternity and parental leave for which they were eligible. In addition, employer “top-up” payments were limited and administrative details of maternity leave were often not discussed fully with pregnant workers. When women returned to work, they found that workplaces did not offer resources such as a phased-in return to work or personnel to help them re-engage with their prior work projects. Women discussed the challenges of managing their dual roles of worker and mother and found that managers and coworkers put them in a mommy mould which lessened the quality of their assignments. New mothers found that they had difficultly juggling their work and home responsibilities, finding time for themselves, and receiving increased domestic support from their spouses. While some workplaces offered women flexible workplace policies, not all mothers chose to access them as they found these policies often negatively impacted their career progression. Other issues were a lack of flexible workplace policy transparency, inconsistent manager support, and difficulty maintaining a flexible schedule. Findings have major implications for an improved response from managers upon pregnancy announcement, improved dialogue among employers about increasing “top up” maternity leave pay to new mothers, developing a formal transition plan for new mothers returning to the workplace, and expanding the use of flexible workplace policies.

The purpose of this study was to examine the perceptions of working women when they announce their pregnancies, take maternity leave, transition back to work, and utilize flexible work policies. Using a qualitative methodology, transcripts of in-depth interviews were analyzed utilizing a life history approach. Key findings of the study are that women perceive more negative responses to the announcement of their pregnancies than positive ones. In terms of maternity and parental leave policies, all the participants had access to these benefits. Women found issues with financial adequacy, administration, and duration of these policies. Mothers found that financial support from the Canadian government was inadequate to allow them to take the full duration of the 52-week maternity and parental leave for which they were eligible. In addition, employer “top-up” payments were limited and administrative details of maternity leave were often not discussed fully with pregnant workers. When women returned to work, they found that workplaces did not offer resources such as a phased-in return to work or personnel to help them re-engage with their prior work projects. Women discussed the challenges of managing their dual roles of worker and mother and found that managers and coworkers put them in a mommy mould which lessened the quality of their assignments. New mothers found that they had difficultly juggling their work and home responsibilities, finding time for themselves, and receiving increased domestic support from their spouses. While some workplaces offered women flexible workplace policies, not all mothers chose to access them as they found these policies often negatively impacted their career progression. Other issues were a lack of flexible workplace policy transparency, inconsistent manager support, and difficulty maintaining a flexible schedule. Findings have major implications for an improved response from managers upon pregnancy announcement, improved dialogue among employers about increasing “top up” maternity leave pay to new mothers, developing a formal transition plan for new mothers returning to the workplace, and expanding the use of flexible workplace policies.