Understanding Factors of Return to Work Among Workers with Occupational Injury Under Social Insurance Compensation: A Sequential Mixed Method

Abstract

Occupational injury is a common cause of prolonged medical absence from work, which leads to loss of productivity and employment. Injured workers under the social insurance protection are facilitated by an established Return to Work (RTW) Program. Therefore, identification of potential biopsychosocial determinants of RTW is essential to ensure effective planning of rehabilitation intervention. The aims of the study are to identify and understand the RTW predictors. A 2-phase sequential mixed method study design was used. The first phase study was to identify the predictors of RTW Program outcome by analyzing the participants’ data pertaining to socio-demographic, biomedical, psychological, social and workplace factors. The main outcome was RTW status of workers at the time of case closure, i.e. either successful or failed RTW. Successful RTW is when a worker RTW for at least 6 months; whereas failed is when a worker unable to RTW or sustained at job for at least 6 months. A total of 3989 occupational injury cases registered were included for the analysis. Multiple regression analysis showed that workers’ age, site of injury, motivation for RTW, self-perceived level of independence and career goal, job type and number of dependents were significant in the final model; of which motivation was identified as the most impactful factors with the highest Wald value. However, the calculated low R squared (0.114) for this model implied that there were other factors influencing the RTW outcome. The subsequent phase 2 explanatory study was conducted to attain in-depth understanding of the workers’ motivation to RTW as key factor of RTW and also to understand relationship between other significant RTW predictors in phase 1 study and RTW outcome. A total of 13 injured workers were interviewed at the rehabilitation center, followed up via telephone interview every 2-monthly until the case closed as successful or failed RTW. Interview questions were targeted to explore the underlying reason of

motivation and how it influenced their RTW outcome. Data were collected using semi- structured interview protocol. Interviews were recorded, transcribed verbatim and

examined for thematic coding and analysis. Thematic analysis identified 4 main themes of RTW motivators: level of self-efficacy, internal desire or external pressure to conform to social norms, aligned expectation on RTW and personal goal to RTW. Availability of job accommodation services and supportive attitude from employers in re-hiring workers with disabilities that form an inclusive workplace were regarded as essential to work re-integration, but not much affecting workers motivation to work again. The RTW predictors from phase 1 regression analysis were indirect contributors to RTW outcome, as each had different roles within the 4 main themes of motivation to RTW and theme of inclusive workplace. In conclusion, RTW is a complex and dynamic process. It is important to gain holistic understanding of workers motivation and its underlying factors as well as all relevant RTW predictors in order to formulate effective and personalized rehabilitation plans.