Determinants represent the major forces at play, modulating disability. These forces can be influenced by several role players. Find out where you fit in this universe, because you are probably one of them.
WHO is this section intended for?
To all (workers, healthcare providers, company players, insurers, family), because it is a shared responsibility.
WHY visit this section?
To better understand :
WHAT is this section about?
Work disability is influenced by several individual, organizational and societal determinants (Figure 2). This section provides a framework to:
Figure 2 – Simplified reference framework of work disability, illustrating the major components and their mutual influence.
WHEN is this information useful?
It is useful at all times, but especially at the beginning of the work rehabilitation process in order to coordinate the efforts of each actor.
HOW can this information be used (applications)?
This information can be used:
Work disability has been the subject of dozens of definitions that have evolved with our understanding of the phenomenon (Lederer et al., 2014).
Work disability is a complex phenomenon influenced by a range of forces, determinants, and factors or systems.
This section provides an overview of this phenomenon to better understand it and to demonstrate the responsibilities of the different stakeholders or role players in return to work (RTW). In addition, it proposes a reference framework that contributes to the adoption of a common language.
To provide RTW stakeholders with a definition and framework that promotes understanding of work disability and the adoption of a common language. This will allow the identification of the stakeholders who play a role in the intervention process as well as fostering communication between the stakeholders and with the worker.
The content is primarily from Lederer, Loisel, Rivard, and Champagne, 2014. We adapted the texts to create a summary version and a full version.
There is no framework (or theoretical model) that considers the perspectives of all RTW stakeholders, much less describes the nature and strength of the interactions between the different risk factors (environmental and personal) and work functioning. We have therefore chosen to present a framework that identifies the forces at play, without illustrating the relationships between these forces.
In order to fully understand work disability, it is necessary to consider the individual, organizational and societal determinants:
Figure 3 – Work Disability Framework. For a complete illustration of all the determinants, see Figure 4 – Framework for Work Disability). This figure shows the different levels of analysis (individual, organizational, societal), the different forces at play (identified by the dark rectangles) and their interactions (arrows). It also shows the role players involved in the return to work (in brackets) and the complexity of work disability, which requires the involvement and consultation of different stakeholders in the work rehabilitation process.
Personal attributes and conditions are physical (e.g., physical abilities), mental, behavioral and emotional (e.g., motivation), social (e.g., relational abilities), economic (e.g., financial restriction), educational or vocational (e.g., competencies), and cultural or symbolic (e.g., meaning of work).
Role player involved: the worker himself/herself, as he/she has an active role to play.
The work environment has physical (e.g., ergonomic conditions), mental, behavioral and emotional (e.g., decision latitude), social (e.g., relationships with colleagues), financial (e.g., job insecurity), structural (e.g., company size), cultural and organizational (e.g., openness to workplace accommodation) dimensions.
Role players potentially involved: co-workers, health or safety committee, employer, human resources, immediate supervisor, union representative.
The insurance and legislative system plays a role of evaluating, labeling and legitimizing. It may or may not allow a worker to receive compensation and vocational rehabilitation services.
Role players potentially involved: compensation agents, lawyers, medical officers, union representatives, work rehabilitation counselors.
The health system offers various rehabilitation services as well as psychosocial interventions. It is also often called upon to determine the existence and severity of work disability through the diagnosis of physical and mental impairments, or at least to “legitimize” or “officialize” these impairments.
Role players potentially involved: occupational therapists, general practitioners, medical specialists (e.g. occupational physicians), psychiatrists, physiotherapists, psychologists, physical rehabilitation technicians.
The social environment refers to family, relatives, micro-networks and community as a source of social or financial support, unpaid workload outside of the workplace (volunteering or housework), family burdens and responsibilities. It can also play a role in labelling, legitimizing or stigmatizing the work disability.
Role players/people potentially involved: friends, family, neighbors, relationships
The socio-politico-economic and cultural environment refers to macrosocial attributes specific to work disability. These attributes were grouped into four dimensions: politicolegal, macroeconomic, sociodemographic, and cultural
Scientific research has generated useful results regarding the worker and his or her work environment, which is the focus of this web site. On the other hand, there are not enough results, or even no research at all, related to the insurance and legislative system, the health system and the worker’s social environment. Finally, we have little influence on the socio-political-economic and cultural environment.
