Assessing significant others’ cognitions and behavioral responses in occupational health care for workers with a chronic disease

Figures & data

Table 1. Characteristics of participating occupational health professionals (N = 192).

Characteristic	Total sample (N = 192) n (%)
Gender
Male	116 (60.4)
Female	76 (39.6)
Age in years (M, SD)	56 (7.6)
Profession
Occupational physician	140 (72.9)
Insurance physician	52 (27.1)
Core task(s)
Supporting workers to retain or return to work	58 (30.2)
Assessment of functional limitations due to illness or disability	24 (12.5)
Providing medical advice regarding issues of injury or illness in relation to work	4 (2.1)
Supporting workers and providing medical advice	25 (13.0)
Assessment of functional limitations and providing medical advice	6 (3.1)
Supporting workers and assessment of functional limitations	15 (7.8)
Supporting workers, assessment of functional limitations, and providing medical advice	24 (12.5)
Missing	36 (18.8)
Work experience (years in practice)
<5	9 (4.7)
5–10	8 (4.2)
11–15	13 (6.8)
16–20	39 (20.3)
>20	123 (64.1)
Employment status
In paid employment	125 (65.1)
Self-employed	60 (31.3)
Both self-employed and in paid employment	7 (3.6)
Self-efficacy to assess and respond to cognitions and behavioral responses of significant others (M, SD)	3.39 (.88)
Organizational norm
Is it customary within your organization for someone in your profession to assess significant others’ responses, behaviors and involvement?
Yes	54 (28.1)
No	55 (28.6)
Not applicable (self-employed)	60 (31.3)
Missing	23 (12.0)
Is it customary within your organization for someone in your profession to assess significant others’ beliefs and expectations?
Yes	40 (20.8)
No	70 (36.5)
Not applicable (self-employed)	60 (31.3)
Missing	22 (11.5)

M: mean; SD: standard deviation.

Figure 1. Distribution of responses for assessment of significant others’ illness perceptions by occupational health professionals (Median = 2.8, IQR = 2.0–3.0).

Figure 2. Distribution of responses for assessment of significant others’ work-related beliefs and expectations by occupational health professionals (Median = 2.5, IQR = 2.0–3.0).

Figure 3. Distribution of responses for assessment of significant others’ behavioral responses by occupational health professionals (Median = 3.0, IQR = 2.9–3.5).

Table 2. Univariate and multiple regression analyses for variables predicting OHPs’ assessment of significant others’ illness perceptions, work-related beliefs and expectations, and behavioral responses.

Variable	Univariate regression			Final regression model (incl. organizational norm)			Final regression model (excl. organizational norm)^a
	B (95% CI)	t	Sig	B (95% CI)	t	Sig	B (95% CI)	t	Sig
Assessment of significant others’ illness perceptions (dependent variable)
(Constant)				2.43 (2.27, 2.60)	28.80	<0.001**	2.27 (1.63, 2.90)	7.05	<0.001**
Gender
Female	−0.26 (−0.51, −0.02)	−2.09	0.04*	–	–	–	−0.24 (−0.48, 0.01)	−1.92	0.06
Male (reference group)	Ref.	Ref.	Ref.	–	–	–	Ref.	Ref.	Ref.
Years in practice
<5 years	−0.52 (−1.08, 0.03)	−1.86	0.07	–	–	–	–	–	–
5–10 years	−0.02 (−0.65, 0.60)	−0.08	0.94	–	–	–	–	–	–
11–15 years	−0.30 (−0.81, 0.21)	−1.15	0.25	–	–	–	–	–	–
16–20 years	−0.16 (−0.47, 0.16)	−0.98	0.33	–	–	–	–	–	–
>20 years (reference group)	Ref.	Ref.	Ref.	–	–	–	–	–	–
Profession
Insurance physician	−0.21 (−0.49, 0.06)	−1.55	0.12	–	–	–	–	–	–
Occupational physician (reference group)	Ref.	Ref.	Ref.	–	–	–	–	–	–
Employment status
Self-employed	0.11 (−0.16, 0.38)	0.82	0.41	–	–	–	–	–	–
Both self-employed and in paid employment	0.46 (−0.16, 1.09)	1.46	0.15	–	–	–	–	–	–
In paid employment (reference group)	Ref.	Ref.	Ref.	–	–	–	–	–	–
Core task
Supporting workers to retain or return to work	0.12 (−0.10, 0.53)	0.55	0.58	–	–	–	–	–	–
Providing medical advice regarding issues of injury or   illness in relation to work	−0.08 (−1.07, 0.92)	−0.15	0.88	–	–	–	–	–	–
Supporting workers and providing medical advice	−0.13 (−0.60, 0.35)	−0.54	0.59	–	–	–	–	–	–
Assessment of functional limitations and providing   medical advice	0.59 (−0.29, 1.47)	1.33	0.19	–	–	–	–	–	–
Supporting workers and assessment of functional   limitations	0.14 (−0.41, 0.70)	0.52	0.61	–	–	–	–	–	–
Supporting workers, assessment of functional limitations   and providing medical advice	0.32 (−0.17, 0.81)	1.29	0.20	–	–	–	–	–	–
Assessment of functional limitations due to illness or   disability (reference group)	Ref.	Ref.	Ref.	–	–	–	–	–	–
Presence of an organizational norm to assess significant   others’ beliefs and expectations
Yes	0.71 (0.43, 0.99)	4.93	<0.001**	0.71 (0.42, 1.00)	4.90	<0.001**	–	–	–
No (reference group)	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	–	–	–
Occupational health professionals’ self-efficacy	0.24 (0.09, 0.38)	3.28	0.001**	–	–	–	0.22 (0.08, 0.36)	3.10	0.002**
Assessment of significant others’ work-related beliefs and expectations (dependent variable)
(Constant)				1.84 (1.24, 2.45)	6.00	<0.001**	1.26 (0.59, 1.94)	3.72	<0.001**
Gender
Female	−0.19 (−0.44, 0.07)	−1.44	0.15	–	–	–	–	–	–
Male (reference group)	Ref.	Ref.	Ref.	–	–	–	–	–	–
Years in practice							–	–	–
<5 years	−0.83 (−1.38, −0.27)	−2.92	0.004**	–	–	–	–	–	–
5–10 years	0.06 (−0.57, 0.68)	.18	0.86	–	–	–	–	–	–
11–15 years	−0.23 (−0.74, 0.28)	−.88	0.38	–	–	–	–	–	–
16–20 years	−0.06 (−0.38, 0.25)	−.39	0.70	–	–	–	–	–	–
>20 years (reference group)	Ref.	Ref.	Ref.	–	–	–	–	–	–
Profession							–	–	–
Insurance physician	−0.33 (−0.61, −0.05)	−2.36	0.02*	−0.36 (−0.66, −0.05)	−2.32	0.02*	–	–	–
Occupational physician (reference group)	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	–	–	–
Employment status							–	–	–
Self-employed	0.01 (−0.26, 0.29)	0.11	0.92	–	–	–	–	–	–
Both self-employed and in paid employment	0.21 (−0.43, 0.85)	0.64	0.52	–	–	–	–	–	–
In paid employment (reference group)	Ref.	Ref.	Ref.	–	–	–	–	–	–
Employment status
Core task
Supporting workers to retain or return to work	0.49 (0.08, 0.90)	2.38	0.02*	–	–	–	0.56 (0.16, 0.95)	2.79	0.006**
Providing medical advice surrounding issues on injury or   illness in relation to work	0.11 (−0.88, 1.10)	0.22	0.83	–	–	–	0.09 (−0.86, 1.03)	.18	0.86
Supporting workers and providing medical advice	0.19 (−0.28, 0.66)	0.82	0.42	–	–	–	0.18 (−0.27, 0.63)	.78	0.44
Assessment of functional limitations and providing   medical advice	0.94 (0.07, 1.82)	2.14	0.03*	–	–	–	0.92 (0.08, 1.75)	2.16	0.032*
Supporting workers and assessment of functional    limitations	0.23 (−0.32, 0.78)	0.83	.41	–	–	–	0.32 (−0.21, 0.85)	1.21	0.23
Supporting workers, assessment of functional    limitations and providing medical advice	0.51 (0.03, 1.00)	2.09	.04*	–	–	–	0.44 (−0.02, 0.91)	1.89	0.06
Assessment of functional limitations due to illness or   disability (reference group)	Ref.	Ref.	Ref.	–	–	–	Ref.	Ref.	Ref.
Presence of organizational norm to assess significant   others’ beliefs and expectations
Yes	0.66 (0.34, 0.97)	4.12	<.001**	0.49 (0.16, 0.81)	2.94	0.004**	–	–	–
No (reference group)	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	–	–	–
Occupational health professionals’ self-efficacy	0.29 (0.15, 0.43)	3.99	<.001**	0.21 (−0.03, 0.39)	2.30	.02*	0.30 (0.13, 0.46)	3.51	0.001**
Assessment of significant others’ behavioral responses (dependent variable)
(Constant)				3.07 (2.92, 3.22)	39.98	< 0.001**	2.65 (2.30, 3.01)	14.64	<0.001**
Gender
Female	0.11 (−0.07, 0.29)	1.17	.24	–	–	–	–	–	–
Male (reference group)	Ref.	Ref.	Ref.	–	–	–	–	–	–
Years in practice
<5 years	−0.50 (−0.92, −0.09)	−2.40	0.02*	−0.54 (0.−0.93, −16)	−2.77	0.006*	−0.52 (−0.92, −0.11)	−2.50	0.01*
5–10 years	−0.64 (−1.08, −0.21)	−2.90	0.004**	−0.73 (−10.17, −0.29)	−3.32	0.001**	−0.67 (−1.100. −0.24)	−3.06	0.003**
11–15 years	−0.29 (−0.64, 0.06)	−1.64	0.10	−0.44 (−0.91, 0.03)	−1.87	0.06	−0.25 (−0.61, 0.11)	−1.37	0.17
16–20 years	−0.29 (−0.51, −0.07)	−2.55	0.01*	−0.33 (−0.60, −0.07)	−2.48	0.01	−0.28 (−0.50, −0.06)	2.51	0.01*
>20 years (reference group)	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
Profession
Insurance physician	−0.15 (−0.35, 0.05)	−1.45	0.15	–	–	–	–	–	–
Occupational physician (reference group)	Ref.	Ref.	Ref.	–	–	–	–	–	–
Employment status							–	–	–
Self-employed	0.02 (−0.18, 0.22)	0.20	0.84	–	–	–	–	–	–
Both self-employed and in paid employment	0.21 (−0.27, 0.70)	0.86	0.39	–	–	–	–	–	–
In paid employment (reference group)	Ref.	Ref.	Ref.	–	–	–	–	–	–
Core task							–	–	–
Supporting workers to retain or return to work	0.30 (−0.002, 0.61)	1.96	0.05	–	–	–	–	–	–
Providing medical advice regarding issues on injury or   illness in relation to work	0.38 (−0.31, 1.06)	1.09	0.28	–	–	–	–	–	–
Combination of supporting workers and providing   medical advice	0.28 (−0.09, 0.64)	1.51	0.13	–	–	–	–	–	–
Combination of assessment of functional limitations and   providing medical advice	0.06 (−0.51, 0.64)	0.22	0.83	–	–	–	–	–	–
Combination of supporting workers and assessment of   functional limitations	0.38 (−0.04, 0.79)	1.79	0.08	–	–	–	–	–	–
Combination of supporting workers, assessment of   functional limitations and providing medical advice	0.33 (−0.04, 0.69)	1.78	0.08	–	–	–	–	–	–
Assessment of functional limitations due to illness or   disability (reference group)	Ref.	Ref.	Ref.	–	–	–	–	–	–
Presence of an organizational norm to assess significant   others’ behaviors, reactions and involvement
Yes	0.53 (0.32, 0.73)	5.05	<0.001**	0.51 (0.31, 0.71)	5.00	< 0.001**	–	–	–
No (reference group)	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	–	–	–
Occupational health professionals’ self-efficacy	0.18 (0.08, 0.29)	3.52	0.001**	–	–	–	0.18 (0.08, 0.28)	3.53	0.001**

*p < 0.05; **p < 0.01.

^a Model summary assessment of significant others’ illness perceptions is F(2, 169) = 7.30, R² = 0.080, p = 0.001; model summary assessment of significant others’ work-related beliefs and expectations is F(7, 132)  =  3.40, R² = 0.153, p = 0.002; model summary assessment of significant others’ behavioral responses is F(5, 178) = 6.41, R² = 0.153, p < 0.001.

Table 3. Description of qualitative data on occupational health professionals’ reasons whether or not to ask about significant others’ cognitions and behavioral responses.

Theme	Theme description	Illustrative quotes from occupational physicians (OP) and insurance physicians (IP)
A. Occupational health professionals’ reasons to ask about cognitions and behavioral responses of significant others^a
1. Significant others as influential factor	To gain insight into the worker’s illness, functioning and social context, because additional information is needed or because of a general awareness or observation that significant others influence the worker, and his/her recovery and re-integration.	“Because this can co-determine the prognosis” (OP) “If I have the impression that significant others slow the worker down in his resumption of work” (OP) “If you notice that they have an obvious influence, for example when discussing a plan to resume work” (OP) “It can be an important supportive factor, but it can also play a role in negative cognitions or stagnation of recovery, for example when a significant other is fearful or has many concerns” (OP) “To get an impression of the extent to which the person concerned is influenced in his or her recovery and re-integration process” (OP) “Because it is known that significant others have a very great influence on absenteeism and the recovery behavior of people” (OP) “Because they can contribute to recovery and participation, but can also inhibit this process” (IP)
2. Significant other as conversation partner	To get additional information about the situation, complaints, coping, and social context of the worker, or to use this information as starting point for more in-depth discussion during the consultation.	“That gives extra information. Hetero anamnesis. Especially when I observe that the significant other has a different opinion than that of the client. This way I receive additional information about: illness insight, level of functioning, degree of support, understanding, interactions at home” (IP) “If I get insufficient information directly from the worker” (OP) “If the client himself cannot sufficiently put it into words” (IP) “Once in a while, if they can give clarification during the consult” (OP) “To gain insight into the social context” (IP) “To check whether expressions of employees are recognized by the partner or significant other. ‘Do you also think it is going better with the person concerned?’ ‘Do you also notice that…” (OP)
3. In response to stagnation of recovery or re-integration	To investigate observed stagnation of recovery, re-integration, or behavioral change.	“If there is inadequate behavior, recurrent setbacks, and clients are not able or afraid to change their behavior” (OP) “Presence of expressions of avoidance and stagnation in recovery and re-integration” (OP) “Because of stagnation in recovery” (OP)
4. Depending on disease characteristics and coping	Because of the characteristics of the disease (e.g., health conditions like mental health or cognitive problems, high complexity or severity), consequences of the disease or coping issues.	“This depends on the disease. With certain diseases, for example after a myocardial infarction, concern of significant others can influence how a sick employee copes with his complaints. Or with an employee with a burnout, because significant others sometimes have an outspoken opinion. In general when it concerns work-related complaints” (OP) “In the presence of mental complaints or obvious mourning because of changed life perspective due to the illness” (IP) “If someone has complaints to the extent that extra support at home could be helpful for recovery or perseverance” (OP) “To assess the coping mechanisms of the insured worker” (IP) “If there are complex problems” (OP) “…more often with psychological complaints, because then the beliefs of significant others have more influence” (OP)
5. Presence of significant other during consultation	Occupational health professional takes advantage of presence of significant others at consultations.	“If they are present during the consult and I have the feeling that some of the not-helpful thoughts originate from the partner” (OP) “Primarily when someone has low work ability or is vulnerable and the partner is present and I check with that person if he sees it the same way” (OP)
6. Topic raised within the natural course of the conversation	To discuss significant others’ cognitions and behavioral responses more in depth if topic is raised in natural course of conversation or is mentioned by the worker.	“I incidentally ask about this if someone raises this topic themselves, but usually this already becomes clear from the behavior of the significant others (I often do ask about this)” (IP) “When this is brought forward in a negative sense” (OP) “I ask about it if an employee comes to me with advice from his or her partner. This can be positive, or very protective” (OP) “When I get the impression from the conversation (for example after asking about social support or when people indicate something about this themselves) that something is going on here” (OP)
B. Occupational health professionals’ reasons not to ask about cognitions and behavioral responses of significant others^b
7. No contribution to better care or assessment	Would not contribute to better care or assessment, or is not considered a relevant topic.	“If it is clear that they give adequate support” (OP) “If recovery is going well, in line with expectations” (OP) “This is not relevant for assessment of functional capacity of an employee” (OP) “If the client himself is sufficiently capable to put it into words” (IP) “This might cause confusion. If you get this information, what do you do with it as insurance physician? How do you weigh this information? Why would you ask about this if you do not plan to do anything with it. You can write down: illness-sustaining factors in the home environment. Which you cannot influence as insurance physician” (IP) “If this does not contribute to re-integration or is not necessary for achieving re-integration goals” (OP) “In case of uncomplicated recovery or obvious adequate coping” (OP)
8. Lack of time	Not enough time to ask about significant others’ cognitions and behavioral responses in addition to other topics to be discussed during consult.	“If I lack time for it or forget it” (OP) “No time, not of first interest” (IP) “It is not yet in my system. In part it is due to lack of time” (OP) “Lack of time” (OP)
9. Focusing primarily on the worker’s perspective	Giving priority to other topics related to experiences and perspectives of the worker.	“Because I want to know the opinion of the person concerned” (IP) “I primarily want to know about the experience of the person concerned” (IP) “In particular, own motivation is important, significant others do not accompany employees to work” (IP) “I do not think those perceptions and expectations in itself influence the employee, rather how the employee him- or herself experiences it” (IP) I initially rely on what the person involved says. If that fits within an activating approach, then I don't see much added value from inquiring about the response from the environment. (OP)
10. Disruptive or hindering influence of significant others	Expectations or fear that asking about significant others’ cognitions and behavioral responses would disrupt the conversation and have negative consequences for worker and re-integration.	“They are often overly concerned” (OP) “Sometimes a significant other is involved in a “wrong” way. Too dominant, disrupting the conversation; a significant other can be a causal factor in the disease process. Then I have already seen the interaction between those two. In that case, the significant other only disrupts the conversation and reduces the quality of the information from the client (e.g., is afraid to speak openly)” (IP) “When it is expected that the significant other wants to take over the conversation from the person concerned” (IP) “If I think this would only uncover more claim behavior, without actual information. Then it would be better if I delve deeper into the underlying emotion instead of focusing on the content” (IP)
11. Sensitive or difficult topic to discuss	Feelings that cognitions and behavioral responses of significant others might be a sensitive topic for workers or that this is a difficult topic to discuss.	“To preserve good relations with the sick worker” (OP) “When this is too sensitive” (IP) “If the employee is not open to this” (OP) “Sometimes I do not ask, to avoid discussion or conflict” (IP) “… sometimes also because it is painful if there is no significant other available” (OP) “Privacy, if it does not matter” (IP) "Resistance or discomfort of the client” (OP)
12. Absence of significant others	Lack of opportunity due to absence of significant others during consultation or because workers do not always have a significant other.	“In my opinion, you can only ask that to the significant other him- or herself, not to the person concerned. Therefore, in my opinion this is only possible if the significant other is present, and this is more often not the case” (OP) “Because significant others are often not present during the conversation” (OP) “If a sick worker is single” (OP) “They are not always present” (IP)
13. Topic is discussed without the need to ask specific questions	Significant others’ cognitions and behavioral responses are discussed in some other way, without the occupational health professional specifically asking about them.	“It is often spontaneously discussed, and I more consciously ask about it if there are signals” (OP) “If the sick employee has already brought it up” (OP) “I invite clients to tell something about their private situation, but do not explicitly ask about reactions, behaviors and involvement of significant others” (OP) “Sometimes it is already clear or spontaneously reported” (IP)
14. Topic is not brought up	Significant others’ cognitions and behavioral responses are not brought up by the worker nor does this topic arise spontaneously during the consult.	“Sometimes it just does not come up” (OP) “If it does not come to it” (IP) “If the person concerned never tells something about his significant others” (OP)
15. Asking about cognitions and behavioral responses of significant others does not come to mind	The occupational health professionals does not think to ask about significant others’ cognitions and behavioral responses during consults, or it has never occurred to the professional to ask about this.	“I don’t always think about it” (OP) “I don’t think about it” (OP) “There are already so many things to ask. It never occurred to me to ask this as well” (OP) “Did not come up with the idea before and often there is already sufficient information from the person concerned” (OP)
16. No reason	No specific or conscious reason.	“No idea. I do not pay enough attention to this” (OP) “No specific reason” (IP) “No good reason actually; I should do this more often” (OP) “Never a conscious reason not to do it, actually” (IP) “Not with any particular reason” (OP)

^a Total of 122 OHPs responded to open question about reasons to ask about significant others’ beliefs and expectations. 131 OHPs responded to open question about reasons to ask about significant others’ responses, behaviors and involvement.

^b Total of 119 OHPs responded to open question about reasons not to ask about significant others’ beliefs and expectations. 104 OHPs responded to open question about reasons not to ask about significant others’ responses, behaviors and involvement.

Data availability

The dataset generated during this study is available from the corresponding author upon reasonable request.