Evidence map›Paper›PMID 40379952›Full record

ArticleJournal of occupational rehabilitation2026

Facilitators and Barriers for a Stepped Care Approach to Promote Return to Work of Employees with Distress: A Multi-perspective Qualitative Study.

Hanneke A M Lettinga, Sandra H van Oostrom, Hendrika P Zijlstra, Johannes R Anema, Karin I Proper

Abstract read
In one paragraph

Article in Journal of occupational rehabilitation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Hanneke A M LettingaCenter for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. hanneke.lettinga@rivm.nl.ORCID https://orcid.org/0000-0003-2569-980X
Sandra H van OostromCenter for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.ORCID https://orcid.org/0000-0003-3086-6641
Hendrika P ZijlstraZorg van de Zaak Netwerk, Utrecht, The Netherlands.
Johannes R AnemaDepartment of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.ORCID https://orcid.org/0000-0001-8657-0917
Karin I ProperCenter for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.ORCID https://orcid.org/0000-0001-7016-1625

Funding

ZonMw 10320052010005
6 · The paper itself

Abstract

purposeA stepped care approach, beginning with a low-intensity e-Health program followed by a high-intensity Participatory Approach led by a return-to-work (RTW) coordinator is a promising intervention to promote RTW of employees on sick leave with distress. As this approach is new, determinants of its successful implementation remain unknown. This study aimed to identify the potential facilitators and barriers for a stepped care approach to promote RTW of employees with distress, from the perspective of employees, employers, and occupational physicians.

methodsA qualitative study was performed consisting of individual semi-structured interviews with 10 employees, 5 supervisors, and two focus groups with 15 occupational physicians. The verbatim transcripts were inductively thematically coded. The Consolidated Framework for Implementation Research (CFIR) was applied to classify themes within its domains.

resultsThemes were constructed belonging to either the implementation or the content of the stepped care approach, falling within the CFIR domains "innovation," "outer setting," "inner setting," and "characteristics of the individual." From all three stakeholder groups, identified facilitators were the tailored program, enabling task adjustments, and the RTW coordinator to stimulate a good communicative relationship between employee and supervisor. Barriers identified were the timing of the stepped care approach, integrating the approach in the current RTW system, and low digital skills.

conclusionBoth facilitators and barriers were found for the implementation of the stepped care approach. This underlines the importance of an adaptive implementation strategy that takes into account workplace dynamics and tailored approaches to support the stakeholder groups' needs.

trial registrationISRCTN: 90663076. Registered on October 5, 2023.

Indexed as

Occupational Health ServicesReturn to WorkAdultFemaleFocus GroupsHumansInterviews as TopicMaleMiddle AgedQualitative ResearchSick LeaveDistressMental healthRehabilitationReturn to workSickness absenceStepped care

Identifiers

PMID40379952
PMCPMC13364892

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.