Table 3 Framework
Theme | People with chronic pain | Employers | Common themes |
|---|---|---|---|
Obstacles to return to work | Psychological obstacles  - Fear and anxiety  - Fear of pain becoming worse  - Worried about what others think (of me)  - Negative experiences in the past Pain related obstacles  - Unpredictability of pain  - Reduced mobility  - Sleep difficulties Financial and economic obstacles  - No financial incentive  - Competitive job market  - Cost to company (productivity) Educational obstacles  - Lack of qualifications  - Challenges of dealing with technology Work history obstacles  - Being out of work for a long time  - Gaps in CV Work environment and nature of work  - Pressure of work  - Finding suitable employment  - Not being able to pull your weight  - Feels work offered is unsuitable  - Unable to fulfil job requirements  - Difficulties fulfilling previous role Employer related obstacles  - Inflexible manager  - Perceived discrimination and unfair treatment  - Employer unwilling to make adjustments  - Being judged by potential employers  - Unsupportive manager | Attitudinal obstacles  - Attitude of person with chronic pain  - Attitudes of others towards people with chronic pain  - Stigma Managerial obstacles  - Managers lack of people skills  - Managers lack of understanding about pain Organisational context  - Reasonable adjustments not possible or affordable  - Dismissal if unable to redeploy  - Ageing work population and increased demand for redeployment  - Conflict between occupational health and employer about what adjustments are reasonable and realistic  - Austerity and limited rehabilitation & resources in NHS  - Culture and size of organisation  - Fairness and potential for conflict with colleagues  - Fear of litigation Capability related obstacles  - Ability to do the job  - Poor performance  - Physical demands of job  - Absence  - Hospital appointments |  - Lack of confidence  - Reliability  - Travelling to work |
Facilitators of return to work | Workplace adjustments  - Temporary job swap  - Finding suitable job  - Flexibility from employer  - Small family run business Good working relationships  - Good relationship with employer, manager and colleagues  - Understanding manager and colleagues  - Being listened to  - Being treated as a person and not a disability  - Help from colleagues Education  - Education for managers about pain  - Understanding of capabilities Preparing for RTW  - Interview preparation support  - Placements  - Support looking for a job  - Training  - Trial period Interventions  - Effective pain relief  - Specialised physiotherapy | Workplace adjustments  - Accommodation of hospital appointments  - Reducing physical demands of job  - Support, training and investment from employer Interventions  - Provision of ergonomic work space  - Coaching  - Individually tailored to support to return to work  - Private medical insurance provided by company  - Occupational health provision Cultural factors  - Caring and compassionate company  - Changing culture and attitudes to employment for people with disabilities and chronic pain  - Political will and coordination of Department of Work and Pensions and Department of Health | Workplace adjustments  - Making changes to job and hours  - Adaptation of the environment or provision of equipment  - Making reasonable adjustments  - Phased return  - Redeployment  - Working from home  - Reduced hours  - Taking breaks  - Light duties  - Help with travelling to work (Access to work or providing transport) Interventions  - Access to cognitive behavioural therapy and counselling  - Access to physiotherapy |
Disclosure of chronic pain to employer |  - Not disclosing during application or interview process  - Fear of not getting an interview or job  - Fear of consequences of not disclosing  - Fear of losing job |  - Disclosure so employer can make reasonable adjustments  - Disclosure to access interventions in the workplace  - Disclosing to occupational health not recruiting manager  - Understanding and accommodating non-disclosure |  - Need to be open and honest |