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

Objective: 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 potential 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 15 occupational physicians. The verbatim transcripts were inductively thematically coded. The Consolidated Framework for Implementation Research (CFIR) was applied to classify themes within its domains. Results: Themes were constructed belonging to either the implementation or the content of the stepped care approach, falling within the CFIR domains "innovation," "outer setting," "inner setting," and "characteristics of the individual." From all three stakeholder groups, identified facilitators were the tailored program, enabling task adjustments, and the RTW coordinator to stimulate a good communicative relationship between employee and supervisor. Barriers identified were the timing of the stepped care approach, integrating the approach in the current RTW system, and low digital skills. Conclusions: Both facilitators and barriers were found for the implementation of the stepped care approach. This underlines the importance of an adaptive implementation strategy that takes into account workplace dynamics and tailored approaches to support the stakeholder groups' needs.

Background: ISRCTN: 90663076. Registered on October 5, 2023.