QualitativeJournal 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 and 2 others

PMID 40379952

WHAT IT FOUND

Stakeholders were split on starting return-to-work support early: some valued structure, others wanted rest first.

They saw psychological safety, an independent coordinator, and medication awareness as important, while digital skills and too many services were barriers.

Key findings

01Stakeholders were split on starting the approach early: some saw it as maintaining structure, while others said the first need was rest.

02All groups saw psychological safety as a precondition, and they viewed an independent return-to-work coordinator as key to equal dialogue between employee and supervisor.

03Medication side effects and lack of medication awareness were described as barriers to return to work, especially when employees did not share medical details with employers.

STILL TO COME

How it was doneWhat they found

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What it does not show

The sample was small and all participants were highly educated, so it may not represent workers with lower education or different backgrounds. Employees had already returned to work, so people who remained absent or did not return may be underrepresented. One researcher had helped design the stepped care approach, which could create a favorable bias toward its feasibility. The study did not test whether the stepped care approach improved return to work. The implementation framework was applied after the interviews, so some details of the framework may not have been explored deeply. The findings are from the Dutch return-to-work system and may not transfer to other settings.

Declared interests

The supplied text does not report funding or a conflict-of-interest declaration. It does say that one researcher helped design the stepped care approach, and the authors note this could create a favorable bias.

The easy way to misread this

Do not read this as proof that the stepped care approach helps people return to work. It only reports what employees, supervisors, and occupational physicians said might help or hinder its implementation. No patient outcomes were tested.

Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →


The study

Participants
10 employees, 5 supervisors, and 15 occupational physicians
Certainty of evidence
Very low

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    Cite

    Hanneke A M Lettinga, Sandra H van Oostrom, Hendrika P Zijlstra, et al. Facilitators and Barriers for a Stepped Care Approach to Promote Return to Work of Employees with Distress: A Multi-perspective Qualitative Study. Journal of occupational rehabilitation. 2026.

    Read the original — we summarise, we never replace the paper.