Towards a parsimonious program theory of return to work intervention

OBJECTIVE: Presentation of a salutogenic theory of return to work (RTW). PARTICIPANTS: The study group include 118 unskilled Danish public employees and privately employed house-cleaners on sick leave due to musculoskeletal and/or common mental illnesses. METHODS: Theory of RTW is discussed from a theoretical and empirical viewpoint, using baseline-data from an intervention study in a longitudinal, non-randomized study design with follow-up after one year. RESULTS: High work ability, strong social support from colleagues and over-commitment are the most important prognostic factors for RTW. An active coping style, high self-efficacy and Sense of Coherence (SOC) are found to increase RTW and high hostility and over-commitment to decrease RTW. Besides health elements in work ability are SOC, self-efficacy, social support and physical activity. Work ability and active coping mediate positive associations between RTW and health, and a negative association with stress. CONCLUSIONS: Work ability seems to express the intention to work decisive for RTW, reflecting the interpretation of the work/health situation based on comprehensibility, meaningfulness and manageability. It is influenced by the personal view of life, attitudes and interaction with the workplace. An ecological theory, integrating health promotion is proposed. A later paper will present the intervention study and further validation of the theory.