Ethical challenges from a problem-solving intervention with workplace involvement: a qualitative study among employees with common mental disorders, first-line managers, and rehabilitation coordinators

ABSTRACT

Purpose

This study aims to explore ethical challenges potentially arising from a problem-solving intervention with workplace involvement (PSI-WPI) in primary health care (with first-line manager involvement) for employees on sickness absence due to common mental disorders.

Methods

A qualitative design guided by the theoretical framework for systematic identification of ethical aspects of healthcare technologies. Semi-structured interviews were performed with coordinators (n = 6), employees (n = 13), and first-line managers (n = 8). Reflexive thematic analysis was used to analyse and interpret themes.

Results

A main theme was identified “the workplace and healthcare hold different organizational value logics” and four sub-themes: “the PSI-WPI challenged the organizational goals and values of the workplace and healthcare”, “the PSI-WPI challenged organizational values on fairness”, “the PSI-WPI challenged the professional roles of first-line managers and rehabilitation coordinators” and “the PSI-WPI introduced a need for the employee to juggle the employee and patient roles”.

Conclusion

Different organizational value logics, values, and goals can introduce ethical challenges. We advise clarifying stakeholders’ roles and preparing employees and managers for the return to work process by providing sufficient information. The ethical challenges and suggested measures to minimize them, should be considered when planning return to work interventions that involve several stakeholders.

KEYWORDS:

• Problem-solving
• sickness absence
• common mental disorders
• depression
• anxiety
• adjustment disorder
• ethical challenges
• work-directed interventions

Abbreviation

PSI-WPI

=

problem-solving intervention with workplace involvement

Acknowledgments

We gratefully recognize the contribution of the employees, first-line managers, and rehabilitation coordinators who participated in the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data is not publicly available due to containing information that could compromise the privacy of the study participants. Reasonable inquiries about access may be sent to Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Box 210, 171 77 Stockholm or by contacting the Research and Data Office at Karolinska Institutet: [email protected]. The Swedish Ethical Review Authority will then be contacted for permission.

Ethics approval and consent to participate

The study was approved by the Swedish Ethical Review Authority on 2017-06-21, reference numbers 496–17, T039–18. Eligible participants received oral and written information about the study, were informed that participation was voluntary, and told that they could withdraw from the study at any time. All participants signed a written informed consent and consented to publication. The study followed the principles of the World Medical Association Declaration of Helsinki (World Medical Association, 2013).

Additional information

Funding

This work was supported by the Swedish Research Council for Health, Working Life and Welfare under Grant number 2018-01252. The funder did not have any part in the design, data collection, analysis, or interpretation of the findings.

Notes on contributors

Ida Karlsson

Ida Karlsson, Reg. Nurse with an Ms in public health and epidemiology. Her research is focused on worker health, intervention research and evaluating interventions.

Lars Sandman

Lars Sandman, Professor in healthcare ethics, focusing on priority setting and ethical analysis of health-care methods.

Iben Axén

Iben Axén, Lic. Chiropractor and Associate Professor, with a special focus on low back pain and intervention research.

Lydia Kwak

Lydia Kwak, Associate Professor and Senior Lecturer in Health Promotion with a special focus on intervention and implementation research and worker health.

Elisabet Sernbo

Elisabet Sernbo, PhD and Associate Senior Lecturer with experience in qualitative methods and social work research.

Elisabeth Björk Brämberg

Elisabeth Björk Brämberg, Reg. Nurse and Associate Professor in Occupational Medicine. Her area of research is the development and evaluation of evidence-based methods in the field of prevention of sick leave, and rehabilitation of persons on sick leave due to common mental disorders.