Implementation of a coordinated and tailored return-to-work intervention for employees with mental health problems

Interventions to promote return to work (RTW) after sickness absence are often complex, involving numerous stakeholders and thus prone to implementation problems. To understand the outcomes of such interventions, researchers need to look beyond effectiveness data and incorporate systematic process evaluations. This article presents findings from a process evaluation of a coordinated and tailored RTW-intervention for employees with mental health problems. The purpose was to elucidate the implementation process and identify barriers for the feasibility and sustainability of the intervention.

The evaluation draws on comprehensive data from observations of and documents from the intervention, a two-waved survey among participants (n = 76), two group interviews with the intervention team, three group interviews with municipal social insurance officers (SIOs), and ten individual interviews with participants.

We identified several barriers to the feasibility and sustainability of the intervention: (1) the inclusion criteria were perceived as too narrow by those responsible for recruitment (SIOs); (2) waiting lists occurred; (3) participants had more severe mental health problems than expected; (4) key stakeholders had divergent expectations of the timeframe for RTW; (5) the SIOs felt insufficiently informed about the intervention; (6) the global financial downturn resulted in many participants losing their job, which impeded workplace-based RTW-efforts.

This study points out important pitfalls in implementing RTW-interventions, pertaining to specification of the target population, consideration of contextual constraints, and ensuring cooperation between key stakeholders. Thorough assessment of local context and stakeholder needs and concerns is likely to improve the feasibility and sustainability of future RTW-interventions.