Motivational Interviewing and Stakeholder Coordination to Improve Return to Work: a randomised, controlled trial with mixed methods

The project: Motivational Interviewing and Stakeholder Coordination to Improve Return to Work: a randomised, controlled trial with "mixed methods" would scrutinize existing NAV interventions to encourage individuals, who have been home-bound due to illness, to return to work (RTW). Through the use of two interventions using motivational interviewing (MI) and "treatment as usual with 2 fixed consultations" (= "TAU2") and an untouched control-group, both quantitative and qualitative measures assessed the successfulness of the interventions using a randomised, controlled trial design with nested qualitative studies. In this project, MI provided two sessions with the sick-listed employee from week 16 of the sickness absenteeism period, while TAU2 will provide NAV contact in the same periods and intervals as an attention bias control condition. This study acknowledged the work of the disability paradigm by addressing both personal and motivational factors as well as interactions with relevant stakeholders. A randomized controlled trial of consenting volunteer participants, ages 18-60, who have been sick-listed for 8-weeks and living in Sør-Trøndelag county were placed in parallel groups. Detailed interventions (through 2-3 workshops) were planned and quality assured during the first phase of the project together with case workers from NAV Sør-Trøndelag, whereby a systematic procedure was developed and instigated. The participants met with the NAV case workers over a year period. Data about return to work (RTW), in addition to health economics evaluations and psychological measurements, were retrieved from the participants using repeated quantitative measures and qualitative data assessed through transcription of dialogue with the workers and stakeholders. Results from the study have been provided in conferences presentations, meetings, journal articles, chronicles and other contributions in media and elsewhere. We have already produced 2 phd's in the project and 6 published articles in international peer-reviewed journals from the project. We are now working with the main effect study, which we hope to publish in 2023, i.e. the main research question addressing possible significant effects of MI on sick-leave, in addition to spin-off articles with qualitative explorations and validation of relevant questionnaires. We launched a two-day national sick-leave conference in November 2022 with our partners NAV and OsloMet, and we have still contact with them about future joint article projects.

I forbindelse med «Nasjonal strategi for arbeid og psykisk helse, 2007- 2012» ble motiverende intervju (MI) introdusert til NAV som et initiativ for å studere MI i tilbakeføring av sykmeldte til arbeid (RTW). Dette var grunnlaget for at prosjektet søkte og fikk støtte av Forskningsrådet til å undersøke bruk av motiverende intervju (MI) i partnerskap med i NAV (Sør-Trøndelag) med et "mixed methods" design som er en kombinasjon av kvalitative og kvantitative metoder. Kvalitative studier i prosjektet viste at MI kunne få fram de sykmeldtes tause kunnskap om egen situasjon, og fikk fram hvor de sykmeldte opplevde kontakten med NAV på et generelt grunnlag, men også hvordan de sykmeldte opplevde å få MI-intervensjon av NAV-veiledere. MI var samtalemetode hvor Nav-ansatte opplevde bedre veiledningskompetanse med en personsentrert tilnærming med de sykmeldte er i sentrum. Det ble også undersøkt og publisert hvordan MI kunne implementeres i NAV med en såkalt prosessavaluering. Prosjektet fikk fram ny viten om forskjeller mellom de på gradert og 100% sykmelding med hensyn til selvrapportert helse, arbeidsplasstilpasningsbredde og psykososialt arbeidsmiljø. Resultatene fra dette arbeidet tyder på at mer oppmerksomhet bør rettes mot selvrapportert helsestatus og arbeidsplasskarakteristikker som ikke fanges opp ved hjelp av registerdata for å forstå RTW-prosesser. En studie i prosjektet identifiserte subgrupper ("klasser") blant langtidssykemeldte individer med såkalt "latent klasse-analyser" og konkluderte med at disse subgruppene/klassene hadde ulik RTW prognose uavhengig av diagnose. Fokus på subgruppers betydning kan i fremtiden muligens hjelpe RTW-tjenester med å gi bedre tiltak i sykefraværsoppfølgingen. Hovedstudien er foreløpig ikke publisert, det vil si spørsmålet om MI har en kvantitativ effekt på sykefraværet på gruppenivå. Prosjektet har vist sykmeldtes opplevelse av NAV generelt, og spesielt deres erfaringer med motiverende intervju gitt av NAV-veileder. Det har vist seg at "enkelte sykmeldte synes at NAV involverer seg for mye, mens andre at NAV involverer seg for lite". Noen vil "være i fred", mens andre ønsker mer aktiv fasilitering av RTW. Prosjektet viste at NAV-veiledere hadde god kompetanseutvikling i bruk av motiverrende intervju, i og med at deres praksis var kvalitetssikret av MI-ekseperter og analysert eksternt. Effekt-studien av MI er ikke avsluttet så det er derfor for tidlig å konkludere om MI har en signifikant effekt på sykefraværet. Hvis MI viser seg å ha effekt på sykefraværet vil dette kunne store medføre økonomiske gevinster for samfunnet. Dette vil kunne evalueres i helseøkonomiske studier. Prosjektet har også prosessevaluert hvordan MI kan implementeres i NAV hvis det er ønskelig.

The project: Motivational Interviewing and Stakeholder Coordination to Improve Return to Work: a randomised, controlled trial with "mixed methods" will scrutinize existing NAV interventions to encourage individuals, who have been home-bound due to illness, to return to work (RTW). Through the use of two interventions using motivational interviewing (MI) and "treatment as usual with 2 fixed consultations" (= "TAU2") and an untouched control-group, both quantitative and qualitative measures will be used to assess the successfulness of the interventions using a randomised, controlled trial design with nested qualitative studies. MI will provide two sessions with the sick-listed employee from week 16 of the sickness absenteeism period, while TAU2 will provide NAV contact in the same periods and intervals as an attention bias control condition. The approach to this study will acknowledge the work of the disability paradigm by addressing both personal and motivational factors as well as interactions with relevant stakeholders. A randomized controlled trial of consenting volunteer participants, ages 18-60, who have been sick-listed for 8-weeks and living in Sør-Trøndelag county will be placed in parallel groups. Detailed interventions (through 2-3 workshops) was planned and quality assured during the first phase of the project together with case workers from NAV Sør-Trøndelag, whereby a systematic procedure was developed and instigated. The participants have met with the NAV case workers over a year period. Data about return to work (RTW), in addition to health economics evaluations and psychological measurements, will be retrieved from the participants using repeated quantitative measures and qualitative data assessed through transcription of dialogue with the workers and stakeholders. The data, including the 1-year follow-up numbers, will be released in January 2022 and analyzed after data-cleaning from March to May 2022. The results will be provided in conferences presentations, meetings, journal articles, chronicles and other contributions in media and elsewhere. We have already produced 2 phd's and 6 published articles in international peer-reviewed journals from the project. We are planning a national sick-leave conference in 2023 with our partners NAV and OsloMet.