| Objectives. Research literature points to a range of "factors" that are associated with return to work outcomes but little understanding of the experience of workers, the strategies used to adapt, how work shapes and influences adjustment, and the trajectories that describe their return to work experience. The aim of this qualitative, workplace-based study was to characterize workers readaptation to the workplace and develop a substantive framework for return to work following disabling cardiac illness. Methods. The study used a concurrent, nested, mixed methods approach, using grounded theory to inform the sampling and analysis framework. Participant workers were 12 males having suffered occupational disability owing to cardiac illness and returning to work at a large auto manufacturing plant. Participants were purposefully sampled for a range of disease and disability experiences as well as a range of work roles in the plant. Data were derived from semi-structured in-depth interviews, standardized questionnaire measures of health-related quality of life and work limitations, observations within the plant, and extensive field notes and memos. Longitudinal information was obtained through follow-up interviews over a two to ten month period. Results. Participants had a range of illness impacts and representations and fulfilled diverse roles in the plant including assembly jobs and trade work. Thematic analysis revealed that participants used adaptive strategies including changing mindset in relation to work, building physical capacity and efficiency, managing relationships and work schedules, and using supports in the plant. Thematic analysis highlighted the importance of the nature of work, the quality of work relationships, organizational practices around accommodation and supports in the workplace including occupational health support. Conclusions. Worker adaptation following disabling cardiac illness involved a process of self-regulation including elements of illness and work representations, deployment of adaptive strategies to compensate for ongoing impairments, self-monitoring, goal setting and adaptive selection of work activities. Work demands, relationships and structures provide a range of possibility for self-regulation and quality of life. Implications for practice for work and health researchers and professionals as well as potential linkages to theory are discussed. |
