Added: Benny Tincher - Date: 10.12.2021 13:27 - Views: 21678 - Clicks: 4177
An interplay of complex issues influence opportunities to gain paid work for people living with long-term conditions, but there are patterns that traverse the various contexts. Synthesising findings across qualitative studies can inform vocational rehabilitation approaches. Seven databases were searched and screened against inclusion criteria. Included studies investigated either lived experiences of gaining paid work while living with a long-term condition or the socio-cultural factors affecting opportunities for paid work.
Findings were extracted from included studies and then analysed using thematic synthesis. Sixty-two studies met inclusion criteria. Identified themes demonstrate that people living with long-term conditions need access to support through the different stages of gaining paid work. This can include considering the benefits and risks of having paid work and negotiating needs in the workplace prior to and during employment.
Positive experiences for workers and employers were influential in changing attitudes about the work-ability of people living with long-term conditions. Findings emphasise the interplay between socio-cultural norms and the constraints experienced in trying to gain work. Appropriately targeted support can unlock possibilities that are otherwise hindered by these norms. Job seekers living with long-term conditions need access to pre-placement advocacy, support to negotiate work-related needs, and support to negotiate difficulties that arise in the job. Vocational rehabilitation initiatives need to have good collaboration with other health services to ensure consistent messages about seeking and managing work.
In many societies, paid work is the main form of income for a vast majority of people. Working has been associated with health benefits related to the structure and opportunities that paid work generates, which include social acceptance and a sense of contribution [ 1—3 ]. Because of these benefits, paid work is a uniquely valued form of occupation. People living with long-term conditions often experience difficulties accessing paid work due to a range of issues, many of which are linked to social attitudes and cultural beliefs about what is possible and appropriate [ 4—8 ].
Aspects of what people experience can be similar across different long-term conditions when the root of the experience is not condition-specific but instead related to cultural norms and the current context of paid work and employment [ 9 ]. However, the limitations attributable to the condition combined with cultural contexts or circumstances can affect what is most relevant to address for each person [ 10—12 ].
While it is important that funding agencies and service providers are aware of the specific and unique issues that might affect individuals depending on their condition and context, it is also useful to analyse what is common across different conditions and across different countries. Knowledge of these common experiences can highlight where we need to concentrate efforts to address persistent barriers to work. Qualitative evidence synthesis QES can be a valuable component in a systematic review of qualitative research, synthesising the findings of multiple studies to generate new insights [ 13 ].
Qualitative studies investigate complex lived experiences and social processes, but they are necessarily specific to the context in which they were conducted. Qualitative evidence syntheses aim to retain the in-depth and nuanced understanding of a phenomenon that is realised in high-quality qualitative research, while generating insights that span the various study contexts [ 13 ]. QES may also be useful to identify new approaches to intervention that need to be tested further [ 14 ]. There are various possible approaches to QES that achieve different aims [ 15 ].
The Cochrane Handbook for Systematic Reviews of Interventions [ 15 ] identifies thematic synthesis [ 16 ] as a clear approach that is capable of producing well-developed themes, especially if applied by a team experienced in qualitative research. There are a few existing qualitative systematic reviews that focus on paid work for people living with various long-term conditions.
A recent qualitative systematic review by Esteban and colleagues [ 17 ] investigated strategies people living with chronic conditions use to integrate or re-integrate into work. This review included studies about remaining in work as well as gaining work, but despite the wide criteria for work outcomes, included a relatively small of studies in the synthesis due to a focus on European countries. Other systematic reviews on the topic of gaining or maintaining paid work have similarly focused on either a specific condition [ 18 ] or specific country [ 19 ].
Furthermore, studies that focus on retaining work for people who are already employed tend to emphasise what is able to be done in the workplace [ 17 ], while one of the key issues for gaining work is getting access to a job and workplace in the first place [ 20 ]. Therefore, there is a strong argument for investigating gaining work separately to retaining work. While a of qualitative studies have been published that focus on gaining work, to the best of our knowledge there have been no qualitative evidence syntheses that have examined this specifically.
Our aim was to focus on gaining work, looking across peer reviewed qualitative literature from a wide range of countries and cultures. The objective for our review was to thematically synthesise qualitative research about engagement in paid work for people living with long-term conditions.
We address two broad questions: What social, cultural, and biographical factors affect opportunities for engagement in paid work for people living with long-term conditions? What are the experiences of people living with long-term conditions with regard to gaining paid work and maintaining that work once gained?
Even in the context of rigorous systematic review methodology, it is important to acknowledge that the de of the search strategy and assessment of relevance affects what literature is accessed and included [ 21 ]. Furthermore, the way that findings are reported affects if and how they are applied in policy and practice. More recent developments in systematic review de have explored explicit stakeholder involvement at key stages of the process to address external validity and transferability of findings [ 22 ].
This QES was one aspect of a multi-stage systematic review of research evidence addressing support to gain paid work for people with long-term conditions. We consulted with four stakeholder reference groups to inform the de, contextualisation and reporting of the qualitative evidence synthesis. This consultation occurred at three key stages in the process—protocol and search strategy development including defining inclusion criteria and generating search termsreviewing the descriptive themes prior to the development of analytic themes, and planning dissemination of findings.
These reference group organisers engaged the members of each reference group 4—6 people per groupwith the remit that each group include a balance of people with lived experience of long-term condition s and people involved in services and advocacy. Travel costs of all group members were covered by the project and they also received a voucher to acknowledge their time and contribution for each meeting. The various conditions for the condition-specific groups were purposively sampled, aiming to achieve diversity with regard to the types of challenges that people might experience in relation to paid work.
We used a pre-planned, comprehensive database search strategy specifying keywords and subject terms adapted for each database. The keywords were generated based on a discussion of terminology and language with our stakeholder reference groups which covered included populations, phenomena of interest and what might be offered by various study des.
Applicability of each study to one or more of the research questions was key to inclusion at full text review. Key definitions in terms of eligibility for inclusion are summarised below.
Detailed inclusion criteria are given in the study protocol [ 24 ]. The review included studies where participants were sixteen years of age or older, who had a long-term condition and were not in paid work at study outset. We considered someone with a long-term condition to be a person living with effects of an injury, illness or health condition that are expected to continue for the foreseeable future. We were specifically interested in experiences regarding trying to gain and maintain paid work.
This included the experiences of people living with long-term conditions and also analyses of the socio-cultural conditions that shape what is possible for those people. Paid work was defined as commencement of either full- or part-time paid work as defined in the Resolution concerning statistics of the economically active population, employment, unemployment and underemployment, adapted by the Thirteenth International Conference of Labour Statisticians October, [ 25 ] or commencement of legal occupation that generates a livelihood e.
Although unpaid work is also important and of interest for this population, we considered it to be ificantly different to the paid work context to warrant specific and separate analysis. We considered all qualitative study des potentially appropriate to addressing the review questions.
This included but were not limited to qualitative descriptive, ethnographic, grounded theory, critical, indigenous and post-structural methodologies. Qualitative evidence syntheses were not eligible for inclusion as there would be potential overlap between these and the other included studies. Where there were several reports on the same study, we included what was needed to provide all eligible findings. For example, a thesis or dissertation would be included and papers based on the thesis or dissertation would be excluded because they covered the same findings in less detail.
We specified a year timeframe for study eligibility due to fast-changing job market conditions, and to ensure the policy environment with regard to employment support structures and funding was as contemporary as possible. We searched seven databases for peer reviewed articles, theses and dissertations for study reports published between 1 January and 28 March Search strategies were deed and tailored to each database using key words and subject heading terms. A high level of study quality was important for inclusion of studies for data extraction as we wanted to ensure that only the findings of studies that were absent of critical quality concerns were included for thematic synthesis.
We considered these critical quality criteria to be appropriate methodology, appropriate de, appropriate data collection, sufficiently rigorous analysis and clear statement of findings.
One search and screening process was applied to identify eligible studies for the two questions reported in this paper and also a third question not reported in this paper which focused on experiences of vocational rehabilitation and employment support services. The team involved in study screening and subsequent quality assessment included three PhD-qualified and experienced qualitative researchers with expertise across vocational rehabilitation JFmental health and occupation KRsocial disadvantage DA, KR, JFrehabilitation and disability JF, KRwith input from the methodological lead for the study WLwho was experienced in qualitative research and conducting Cochrane reviews related to rehabilitation.
Study inclusion depended on the study meeting inclusion criteria specified in the pre-published protocol and addressing one or more of the research questions. Two review authors independently considered the titles and abstracts from the studies identified and screened for qualitative methodologies and relevance to the research questions. Full text screening was carried out for all studies that were identified as possibly meeting inclusion criteria at title and abstract screening. Disagreement or uncertainty about relevance at any stage was resolved through consideration and discussion of full study reports, involving a third review author where necessary.
All studies that met the scope of one or more of the questions were assessed for methodological quality using Sections A and B of the Critical Appraisal Skills Programme qualitative checklist [ 26 ]. Section A six items assesses the study de as it affects validity of.
Section B three items addresses the reporting of directly. Section C was not included in quality assessment for this qualitative evidence synthesis as it focuses on external validity, which is specific to the local context where the study is to be applied. If they could not be reached or could not provide the requested information, the study was excluded from data extraction. Included studies were categorised by consensus according to their primary focus socio-cultural factors or lived experiences.
For each study, we then extracted the following available data: full citation, corresponding author, year published, country, data type e. JF led the coding and development of descriptive themes from the studies that were categorised as having a socio-cultural focus, being most experienced with critical and post-structural study des. DA led the coding and development of descriptive themes from the studies that were categorised as focused on lived experiences, being experienced with descriptive and interpretive study des. Coding was inductive, in which each segment of text was attributed codes which represented its content and meaning.
Over the course of coding the studies, a bank of codes was built up and adjusted in an ongoing process to reflect the material held within each code. As part of our coding process, we explicitly noted differences relating to condition or local context where pertinent. Code description and content was discussed and debated among the first three authors at regular meetings with reference to the contributing study findings.
This was to test assumptions, challenge interpretations and raise questions. Once we had completed coding, the team grouped and organised the various codes into descriptive themes for the next stage of the process.
Descriptive themes for each category socio-cultural influences and lived experiences were presented in stakeholder reference group meetings for discussion and debate, often referring back to the findings of the primary studies but also initiating an exploration of the relationship between the descriptive themes and the research questions for the synthesis. It was clear from these discussions that the descriptive themes focused on socio-cultural influences often helped contextualise and understand the descriptive themes focused on lived experiences.
These discussions enabled the research team to develop the analytic themes which are more theoretically driven—considering how the various descriptive themes contribute to and challenge each other, therefore going beyond the findings of the primary studies to address the synthesis-focused research questions. The analytic themes that we report here address both research questions together, as treating the questions as two aspects of a larger whole provided richer analytic themes than would have been possible if we had kept them separated. The database search identified records for title and abstract screen after removing duplicates.
Of these, were eligible for full-text screen. After full text review, we had studies fitting the scope of one or more of the questions.
Of the 82 studies, 27 studies addressed question one, and 35 studies addressed question two reported in this paper. There were also 20 studies that addressed the third question about experiences of services reported separately. Figure 1. Detail of contextual characteristics of studies is provided in Table 1. Studies that scored higher on our non-critical questions generally had richer or more nuanced findings than lower scoring studies, meaning that they naturally contributed more to the findings of the synthesis.27 seeking long term
email: [email protected] - phone:(680) 215-6225 x 4994
In U.S., Depression Rates Higher for Long-Term Unemployed