Sumud at Work: Theory-Based Development of an Occupational Therapy Intervention for Staying at Work with Chronic and
1Occupational Therapy Department, Arab American University, West Bank, Palestine. husam.taha@aaup.edu.
Purpose:
Work disability prevention research presumes formal systems (sick leave, graded return to work, accommodation legislation, disability insurance) that are absent for workers in informal and conflict-affected labor markets. This paper reports the theory-based development of Sumud at Work, a prototype occupational therapy intervention for staying at work among Palestinian workers with chronic and episodic hand conditions.
Methods:
An intervention development study using a combined theory- and evidence-based approach within the development phase of the Medical Research Council framework, reported per GUIDED. Three steps were followed: synthesis of stay-at-work, self-management, and contextual evidence; theoretical modeling using the Sumud-MOHO framework mapped against the work disability arena model; and specification of a program theory, logic model, and manualized intervention described per TIDieR.
Results:
The prototype specifies four modules for approximately four occupational therapy contacts after a joint surgeon and occupational therapist first visit: a narrative module intended to reframe protective work strategies as strategic steadfastness (Sumud); a protection module operationalizing flare-contingent two-track work routines, splinting, and tool adaptation (Sutra); a mutual-help module mobilizing family and community labor exchange as a proposed substitute for formal accommodation ('Awna); and a documentation module recording structural barriers, including checkpoint-related disruption, within routine care. All mechanisms are hypotheses; guardrails distinguish sustainable from sacrificial steadfastness and keep disclosure worker-controlled.
Conclusion:
The prototype proposes relocating accommodation from absent institutions to cultural and collective practices and adds a political landscape layer to the work disability arena model. Its mechanisms are untested and its transferability beyond Palestine unestablished. Co-design, feasibility testing, and evaluation follow.
