To date, mental health problems have been increasingly related to long-term sick leave and disability , but work-related mental health problems and workload are not easily discussed in the workplace . Even when the afflicted employees are in contact with health care providers they find these problems difficult to mention and discuss . The results of some recent studies indicate that sick leave due to this type of complaints can be reduced by activating interventions: an activating intervention supervised by the occupational physician (OP) , a combined individual and workplace intervention supervised by labour experts , occupational therapy for major depression , and a minimal intervention strategy, concentrating on work resumption, provided by the general practitioner . These studies showed that earlier return-to-work (RTW) is not associated with an increase or decrease in complaints [4–7], but is seen as part of the recovery process. It could assist an employee to regain control and to recover more quickly. However, there is still no structured protocol available to identify (work-related) mental health problems, to discuss them, and to find solutions to facilitate RTW.
A protocol to facilitate RTW is available for employees with low back pain, and a recent study reported promising results [8–10]. This Participatory Workplace (PW) intervention is based on principles used in Participatory Ergonomics . The PW intervention consists of a stepwise process to identify and solve barriers for RTW, based on consensus between the sick-listed employee and his/her supervisor about a plan to facilitate RTW. Employees are first referred to an RTW coordinator (in most cases an ergonomist) by their OP. Then, the employee and supervisor identify barriers for RTW separately in structured conversations with the RTW coordinator, based on a task-analysis. In a third conversation the employee, the supervisor and the RTW coordinator brainstorm together to find solutions, resulting in a plan for RTW, based on consensus. One of the essential features of the protocol is that the RTW coordinator's role is predominantly that of guiding the process, not that of an occupational health (OH) professional who decides what is wrong and what should be done about it. The actions planned are those that both the employee and the supervisor have proposed and decided upon.
This protocol accelerated RTW by 27 days [9, 12] and both the compliance and satisfaction with the intervention were good for employees and OH professionals . This PW intervention may also be applicable for employees who are on sick leave due to mental workload and stress . Secondary analysis of participants with both low back pain and problems related to mental workload or stress, showed that the intervention made it possible to identify mental workload and stress issues, to discuss them and to cope with them. Obstacles for RTW related to mental health were identified as job strain, work atmosphere and personality characteristics of the worker. Compared with obstacles related to physical workload, the solutions for mental workload and stress were more often found in job content and work organisation. Based on their results, Jettinghoff recommended that a prospective study should be carried out to assess the applicability and effectiveness of the PW intervention for sick-listed employees with stress-related mental disorders (SMDs) .
It was decided to develop a workplace intervention for sick-listed employees with SMDs, based on the promising RTW intervention for low back pain. However, the implementation of evidence-based RTW interventions in occupational health has been difficult , due to the absence of key stakeholder involvement in the development of such interventions [15–18]. Goldenhar et al. suggest the development of a research agenda to carry an OH intervention through all three phases: development, implementation and evaluation . In health education and health promotion research, interventions have been developed and implemented in a very structured manner. A structured process such as Intervention Mapping (IM) is often applied in the development of an intervention in this field of research. IM includes both knowledge obtained from the literature and involvement of key stakeholders to develop, implement and evaluate an intervention [19, 20]. The application of IM in the development of interventions in OH research is a challenge, and to our knowledge this will be the first time such a process was used to develop an RTW intervention in the field of OH.
This paper describes the process of adjusting the protocol of the PW intervention for sick-listed employees with SMDs, and applying IM principles that make it possible to tailor the intervention to this specific target group.