What do employers need when supporting stroke survivors to return to work?: a mixed-methods study

Employers are key in supporting stroke survivors to return to work (RTW) but do not always have knowledge/skills or guidance to do so. To explore employers’ needs for provision of post-stroke RTW support. Mixed-methods study. Participants recruited through voluntary response/purposive sampling. Survey of employers investigated stroke knowledge (maximum score: 7), RTW process knowledge (maximum score: 8), and perceived competency for actions supporting RTW (maximum score: 100%). Regression analyses explored relationships between employers’ demographic/contextual characteristics and knowledge and perceived competency scores. Interviews with employers explored factors influencing their post-stroke RTW support. Interview data were analyzed using a framework analysis. Survey/interview findings were synthesized with those from a qualitative systematic review. Across the survey (<i>n</i> = 50), interviews (<i>n</i> = 7), and review (25 studies), employers’ support was influenced by stroke survivors’ decisions to disclose stroke-related limitations, employers’ knowledge regarding roles/responsibilities, employers’ communication skills, and information provided by healthcare. Regression analyses: Human resources/occupational health support was positively associated with stroke knowledge (ß = 2.30, 95% CI 0.36–4.41, <i>p</i> = 0.013) and RTW process knowledge (ß = 5.12, 95% CI 1.80–6.87, <i>p</i> = 0.001). Post-stroke RTW experience was positively associated with stroke knowledge (ß = 1.36, 95% CI 0.46–2.26, <i>p</i> = 0.004) and perceived competency (ß = 31.13, 95% CI 18.40–44.76, <i>p</i> = 0.001). Organization size (i.e. working in a larger organization) was positively associated with RTW process knowledge (ß = 2.96, 95% CI 1.52–4.36, <i>p</i> = &lt;.001). Employers’ RTW support was influenced by personal and environmental factors; they may benefit from education and guidance on stroke and their roles/responsibilities during the RTW process.

雇主是助力脑卒中（stroke）幸存者重返工作（Return to Work, RTW）的核心主体，但多数雇主往往缺乏相应的知识、技能与指导方案以开展相关支持工作。
本研究旨在探索雇主为脑卒中幸存者提供卒中后重返工作支持的实际需求。
本研究采用混合研究方法。
研究对象通过自愿回应抽样与目的性抽样方式招募。
针对雇主开展的问卷调查涵盖三项评估内容：脑卒中相关知识（满分7分）、重返工作流程相关知识（满分8分），以及雇主对开展支持重返工作相关行动的感知胜任力（满分100%）。
回归分析用于探究雇主的人口统计学特征与情境特征，与其知识得分、感知胜任力得分之间的关联。
对雇主开展的访谈旨在探索影响其提供卒中后重返工作支持的各类因素。
访谈数据采用框架分析法进行编码与分析。
研究将问卷调查、访谈结果与一项定性系统综述的结论进行了整合分析。
本次研究共纳入50份有效问卷、7份访谈样本及覆盖25项研究的定性系统综述，结果显示雇主的支持行为受多方面因素影响：脑卒中幸存者是否选择披露其脑卒中相关功能受限情况、雇主对自身角色与责任的认知水平、雇主的沟通能力，以及医疗保健机构提供的相关信息。
回归分析结果显示：企业人力资源/职业健康支持与脑卒中相关知识得分（β=2.30，95%置信区间0.36~4.41，p=0.013）、重返工作流程知识得分（β=5.12，95%置信区间1.80~6.87，p=0.001）均呈显著正相关。
拥有卒中后重返工作支持经验与雇主的脑卒中相关知识得分（β=1.36，95%置信区间0.46~2.26，p=0.004）及感知胜任力得分（β=31.13，95%置信区间18.40~44.76，p=0.001）均呈显著正相关。
企业规模（即就职于大型企业）与雇主的重返工作流程知识得分呈显著正相关（β=2.96，95%置信区间1.52~4.36，p<0.001）。
雇主的重返工作支持行为受个体与环境双重因素影响；针对脑卒中相关知识及雇主在重返工作流程中的角色与责任开展教育培训与指导，或可有效提升其支持能力。