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Project

The role of motivation in return to work after work disability

Background: Motivation is a much-discussed topic in the context of work disability. The increasing number of long-term sickness is often linked to a lack of motivation by both policymakers and the general population. However, these are assumptions that have not been thoroughly investigated scientifically until now. This dissertation attempts to fill this gap. The research first maps to what extent motivation can be measured in the context of RTW using a validated instrument. Second, the predictive value of motivation of the person on disability is examined. Third, a motivational interviewing (MI) style is compared the consult as usual (CAU), on the assumption that we can motivate "better" than we do today, grounded in scientific research.
Methods: The dissertation consists broadly of an analytical section and an interventional section. The analytical section consists of two phases. First, a cross-sectional questionnaire study is performed to answer the research question on whether motivation could be measured (Chapter 1). If this part of research reveals that a diversity of quality in motivation can also be found in the group of people in work disability, its predictive value can be investigated. Therefore, a longitudinal questionnaire study is conducted to quantify the relative contribution of motivational risk factors in RTW (Chapter 2). Next, an interventional section with mixed methods evaluation takes place to investigate whether motivation of people with a work disability can be influence with MI. In a piloting randomized controlled trial (RCT), MI was compared to how consultations in case of work disability are conducted to date (CAU) (Chapter 3). In parallel, a qualitative study on the basis of realistic evaluation of Tilley and Pawson (2000) was conducted to study not only the RTW outcomes, but also the experience with MI of people on work disability and the working mechanisms of MI (Chapter 4).
Results: Motivation can be measured according to SDT terms (Chapter 1). Moreover, motivation is not a binary concept, but different types of motivation can coexist. Participants with a controlled motivation reported to expect a longer duration of work disability before RTW, and worse mental quality of life. Having an autonomous motivation does not seem to be a protective factor for detrimental outcomes of a controlled motivation. The longitudinal study (Chapter 2) revealed that controlled motivation regarding the former job was related to shorter time until RTW. The frustration of the basic needs was related to a longer work disability. In Chapter 3, patients in the MI group showed faster RTW and had a lower chance of relapse compared to those in the CAU condition. The underlying mechanisms and context variables were further explored in Chapter 4, where supporting autonomy, affirmation and focusing on possibilities were perceived as the main working mechanisms. The research also reveals that contextual factors cannot be ignored.
Discussion: The use of SDT’s conceptualization of motivation allows a nuanced perspective on motivation. The association between the estimated motivation of the patient by the health care provider and motivation measured by a questionnaire was underwhelming, which argues that we cannot adequately assess motivation based on gut feeling. Furthermore, frustration of the basic psychological needs was predictive for a longer work disability. Based on our results, there is some evidence that MI helps work-disabled patients to RTW faster and experience less relapse. MI led to both proximal and distal outcomes in RTW. The working mechanisms were all related to MI, SDT and solution-focused counseling.

Date:3 Feb 2017 →  19 Dec 2022
Keywords:occupational medicine, motivation, return to work
Disciplines:Public health care, Microbiology, Systems biology, Laboratory medicine
Project type:PhD project