Facilitators and Barriers for a Stepped-Care Approach to promote Return to Work of Employees with Distress. A Multi-Perspective Qualitative Study

Purpose. A stepped-care approach, beginning with a low-intensity e-Health program followed by a high-intensity Participatory Approach led by a return-to-work (RTW) coordinator is a promising intervention to promote RTW of employees on sick leave with distress. As this approach is new, determinants of its successful implementation remain unknown. This study aimed to identify the expected facilitators and barriers for a stepped-care approach to promote RTW of employees with distress, from the perspective of employees, employers and occupational physicians. Methods. A qualitative study was performed consisting of individual semi-structured interviews with 10 employees, 5 supervisors and two focus groups with (in total) 18 occupational physicians. The verbatim transcripts were first thematically coded, final themes and names were constructed based on The Consolidated Framework for Implementation Research (CFIR). Results. Themes within the CFIR domains “innovation”, “outer setting”, “inner setting” and “characteristics of the individual” were identified. From all three perspectives, identified facilitators were the tailored program, enabling adjustment of tasks to the need of the employee and the RTW-coordinator to stimulate a good communicative relationship between employee and supervisor. Barriers identified were the timing of the stepped-care approach, the possibility of having too many services deployed at the same time for the employee, and low digital skills . Conclusion. Successful implementation of the stepped-care approach requires attention to all four CFIR domains. The possibility to tailor the intervention, supporting communication and balancing service delivery are important to facilitate the implementation of the stepped-care approach. Trial Registration : ISRCTN: 90663076. Registered on 5 October 2023.