Do workers with long-term health conditions need self-management support at work?

BACKGROUNG. Due to an ageing population and longer working lives, long-term health conditions are an increasing global burden and particularly among people of working age. A long-term health condition (LTC) can affect people’s workability and lead to premature work exit. Supporting a worker’s self-management of LTCs has the potential to minimise adverse effects through enhanced health and work outcomes. Evidence suggests that self-activation, self-efficacy, empowerment and support from others can promote LTC self-management in general and that psychosocial factors interact to influence health, but little is known about workers’ support needs. No data exists on employers’ perspectives of what self-management support workers with LTCs require. Utilising self-efficacy theory, the Patient Activation® concept and a psychosocial framework, this project aimed to understand if workers with LTCs need workplace self-management support.

METHOD. The project adopted a mixed methods approach with four inter-related studies. Participants completed a cross-sectional online survey questionnaire (Study 1) measuring demographic and LTC characteristics, activation, self-efficacy, quality of life (QoL), wellbeing, workability and working conditions (stressors). For the survey, 736 workers including 327 with mental health, musculoskeletal (MSK) and other LTCs were recruited from across industries. In order to establish a longitudinal picture of changes and patterns in workers LTCs, self-management and work characteristics a sub-sample (n = 67) participated in a 10 week online diary study (Study 2). Participants’ LTC information, perceived control of an LTC, self-management activities, LTC and work interactions, received support, support satisfaction and work engagement were measured. The exploration of employers’ views on worker’s LTC self-management (Study 3) involved recruiting 15 participants with responsibilities for health and wellbeing, who participated in a semi-structured interview about self-management and support. Lastly, 14 workers participated in a narrative interview (Study 4) exploring their experiences of self-managing an LTC at work. Data were analysed using quantitative statistics for the survey and online diary (ANCOVAs, t-tests, chi-square tests, regression and multi-level modelling) and qualitative techniques for the interview studies (content, thematic, narrative thematic and narrative structural analyses).

RESULTS. Of 736 participants completing the Study 1 survey, 327 reported a diagnosed LTC including mental health n = 119, MSK n = 94 and other n = 114 conditions. Participants without LTCs (n = 409) reported more people to turn to at work for support [F(1, 730) = 9.67, p = 0.002], better manager [F(1, 729) = 14.2, p = 0.001] and peer support [F(1, 729) = 12.1, p = 0.001], better current workability [F(1, 730) = 58.9, p = 0.001] and less stress about control [F(1, 729) = 5.21, p = 0.023] and change [F(1, 729) = 5.18, p = 0.009]. When compared to workers with MSK and other LTCs, workers with mental health conditions reported reduced current workability (p = 0.014), manager support (p = 0.008) and wellbeing (p = 0.001) and increased stress about change (p = 0.028) and role (p = 0.049). Differences in activation (p = 0.006) but not self-efficacy (p = 0.158) emerged between mental health and all other LTCs suggesting workplace support is important. Increased activation scores were associated with increased self-efficacy (p = 0.001), wellbeing (p = 0.001) and current workability (p = 0.001). Workers who had not disclosed an LTC (mainly mental health) reported less workplace support (p = 0.001) and were non-significantly more activated and self-efficacious. Increasing LTC severity was associated with reduced self-efficacy (p = 0.001), wellbeing (p = 0.001) and current workability (p = 0.001). Increasing age was associated with higher activation and self-efficacy together with current and future workability. Significant variability in the change of participants self-management confidence over time was revealed (B = 1.43, SE = 0.62, p = 0.02). Interactions between self-management confidence and support satisfaction and time were not significant (p = 0.61), nor between self-management confidence, LTC control and time (p = 0.62). However, interactions between self-management confidence and work engagement were significant [F(1, 54) = 1.69, p = 0.027]. Qualitative data from studies 3 and 4 provide insight into workplace LTC self-management. Data from the survey and diary study suggest that support in respect of flexibility, leeway, openness and reasonable job demands will be helpful. This was reinforced by the narrative interview data that work-modifications, disclosure, low levels of stigma, and relational support from managers and colleagues was important to workers. The employer interview study findings suggest that self-management support is not purposely provided to workers with LTCs and that managers have a main support role. Employers made it clear that workers are expected to disclose an LTC for support to be offered and recognised that obstacles to support include poor manager behaviour, stigma and work demands.

CONCLUSION. This research examined if workers with LTCs need workplace self-management support. The findings from the studies reported in this thesis lead to the conclusion that workers do. This has important implications for employers. Psychosocial factors interact to affect workers ability to fit self-managing around work. Findings suggest that workers confidence and empowerment to self-manage rests largely on managers supporting flexibility, leeway and autonomy. Yet, employers lack awareness and self-management support is not purposely provided. Whilst employers and managers might not realise the control they exert on workers LTC self-management, they have an important role to play and need guidance in the principles and practice of supporting self-management. This research identifies support needs specific to the workplace and proposes a model for psychosocial LTC self-management support. This can be used to generate discussions about obstacles and support needs to guide workers and employers. Potentially, the model can inform the design of a LTC self-management support tool for managers and update existing self-management support models.