학술논문

Constructing therapeutic support and negotiating competing agendas: A discourse analysis of vocational advice provided to individuals who are absent from work due to ill-health.
Document Type
Academic Journal
Author
Saunders BChew-Graham CSowden GCooke K; Keele University, UK.; Walker-Bone K; University of Monash, Australia.; University of Southampton, UK.; Madan IParsons V; King's College London, UK.; Guy's and St Thomas' NHS Foundation Trust, UK.; University of Southampton, UK.; Linaker CH; University of Southampton, UK.; Wynne-Jones G; Keele University, UK.
Source
Publisher: Sage Publications Country of Publication: England NLM ID: 9800465 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1461-7196 (Electronic) Linking ISSN: 13634593 NLM ISO Abbreviation: Health (London) Subsets: MEDLINE
Subject
Language
English
Abstract
Work participation is known to benefit people's overall health and wellbeing, but accessing vocational support during periods of sickness absence to facilitate return-to-work can be challenging for many people. In this study, we explored how vocational advice was delivered by trained vocational support workers (VSWs) to people who had been signed-off from work by their General Practitioner (GP), as part of a feasibility study testing a vocational advice intervention. We investigated the discursive and interactional strategies employed by VSWs and people absent from work, to pursue their joint and respective goals. Theme-oriented discourse analysis was carried out on eight VSW consultations. These consultations were shown to be complex interactions, during which VSWs utilised a range of strategies to provide therapeutic support in discussions about work. These included; signalling empathy with the person's perspective; positively evaluating their personal qualities and prior actions; reflecting individuals' views back to them to show they had been heard and understood; fostering a collaborative approach to action-planning; and attempting to reassure individuals about their return-to-work concerns. Some individuals were reluctant to engage in return-to-work planning, resulting in back-and-forth interactional negotiations between theirs and the VSW's individual goals and agendas. This led to VSWs putting in considerable interactional 'work' to subtly shift the discussion towards return-to-work planning. The discursive strategies we have identified have implications for training health professionals to facilitate work-orientated conversations with their patients, and will also inform training provided to VSWs ahead of a randomised controlled trial.
Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.