119 Developmental evaluation: a fruitful strategy for implementing and evaluating a work rehabilitation program for workers with common mental disorders


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Abstract

IntroductionIn Canada, few early work rehabilitation services are offered to prevent long-term work disability due to common mental disorders (CMD), despite population-level needs. Our study aimed to support and evaluate the implementation and effects of an innovative program designed to promote post-CMD return-to-work (RTW) in primary healthcare.MethodsA developmental evaluation approach (Patton, 2011) was retained. Main implementation strategies consisted of periodically revising the program’s logic model and discussing its underlying theory of change with clinicians. Data collection tools included: dashboards of activities conducted with participants (n=41); interviews with participants upon discharge (n=26) and 6 months post-discharge (n=24); questionnaires completed by attending physicians (n=18). Quantitative data underwent descriptive statistical analyses, while qualitative data underwent thematic analysis. Results were presented and discussed periodically with clinicians to ensure their credibility.ResultThe implemented program included group interventions, one-on-one interventions, and concerted actions with partners. Participants began the program after 5 months of sick leave on average, and participated for 10±2 weeks. 80% of cases included concerted actions, usually with insurers and rarely attending physicians. However, virtually all the physicians saw the program as meeting needs and promoting RTW. Active components identified by participants concerned primarily the interventions’ group format, but also activities, and clinicians themselves. In terms of the program’s final expected outcome, 69% of the participants returned to work upon discharge and 79% were at work 6 months post-discharge.DiscussionThe program studied is based on the best scientific evidence and is feasible in a primary healthcare context. Results suggest that it facilitates a sustainable RTW of workers with a CMD and that it supports physicians in their interventions with this population. While additional work is required to demonstrate its effectiveness, current results suggest that a group format is an important intervention component for this target population.

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