{
  "abstract": "Objectives A 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.Material and Methods A 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.Results Themes 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.Conclusion Both 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.",
  "authors": [
    {
      "affiliations": [
        "Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. Zorg van de Zaak Netwerk, Utrecht, The Netherlands"
      ],
      "name": "Hanneke Lettinga"
    },
    {
      "affiliations": [
        "Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. Zorg van de Zaak Netwerk, Utrecht, The Netherlands"
      ],
      "name": "Sandra H van Oostrom"
    },
    {
      "affiliations": [
        "Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. Zorg van de Zaak Netwerk, Utrecht, The Netherlands"
      ],
      "name": "Hendrika P Zijlstra"
    },
    {
      "affiliations": [
        "Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. Zorg van de Zaak Netwerk, Utrecht, The Netherlands"
      ],
      "name": "Johannes R Anema"
    },
    {
      "affiliations": [
        "Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. Zorg van de Zaak Netwerk, Utrecht, The Netherlands"
      ],
      "name": "Karin I Proper"
    }
  ],
  "title": "8233037 Facilitators and barriers for a stepped-care approach to promote RTW of employees with distress",
  "uid": "60771d23-d488-5b17-8fa0-26bb6e9630b1"
}