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NASW members can access articles online at: Social Work Research

Social Work Research publishes exemplary research to advance the development of knowledge and inform social work practice. Widely regarded as the outstanding journal in the field, it includes analytic reviews of research, theoretical articles pertaining to social work research, evaluation studies, and diverse research studies that contribute to knowledge about social work issues and problems.

Social Work Research Methods That Drive the Practice

Social workers advocate for the well-being of individuals, families and communities. But how do social workers know what interventions are needed to help an individual? How do they assess whether a treatment plan is working? What do social workers use to write evidence-based policy?

Social work involves research-informed practice and practice-informed research. At every level, social workers need to know objective facts about the populations they serve, the efficacy of their interventions and the likelihood that their policies will improve lives. A variety of social work research methods make that possible.

Data-Driven Work

Data is a collection of facts used for reference and analysis. In a field as broad as social work, data comes in many forms.

Quantitative vs. Qualitative

As with any research, social work research involves both quantitative and qualitative studies.

Quantitative Research

Answers to questions like these can help social workers know about the populations they serve — or hope to serve in the future.

• How many students currently receive reduced-price school lunches in the local school district?
• How many hours per week does a specific individual consume digital media?
• How frequently did community members access a specific medical service last year?

Quantitative data — facts that can be measured and expressed numerically — are crucial for social work.

Quantitative research has advantages for social scientists. Such research can be more generalizable to large populations, as it uses specific sampling methods and lends itself to large datasets. It can provide important descriptive statistics about a specific population. Furthermore, by operationalizing variables, it can help social workers easily compare similar datasets with one another.

Qualitative Research

Qualitative data — facts that cannot be measured or expressed in terms of mere numbers or counts — offer rich insights into individuals, groups and societies. It can be collected via interviews and observations.

• What attitudes do students have toward the reduced-price school lunch program?
• What strategies do individuals use to moderate their weekly digital media consumption?
• What factors made community members more or less likely to access a specific medical service last year?

Qualitative research can thereby provide a textured view of social contexts and systems that may not have been possible with quantitative methods. Plus, it may even suggest new lines of inquiry for social work research.

Mixed Methods Research

Combining quantitative and qualitative methods into a single study is known as mixed methods research. This form of research has gained popularity in the study of social sciences, according to a 2019 report in the academic journal Theory and Society. Since quantitative and qualitative methods answer different questions, merging them into a single study can balance the limitations of each and potentially produce more in-depth findings.

However, mixed methods research is not without its drawbacks. Combining research methods increases the complexity of a study and generally requires a higher level of expertise to collect, analyze and interpret the data. It also requires a greater level of effort, time and often money.

The Importance of Research Design

Data-driven practice plays an essential role in social work. Unlike philanthropists and altruistic volunteers, social workers are obligated to operate from a scientific knowledge base.

To know whether their programs are effective, social workers must conduct research to determine results, aggregate those results into comprehensible data, analyze and interpret their findings, and use evidence to justify next steps.

Employing the proper design ensures that any evidence obtained during research enables social workers to reliably answer their research questions.

Research Methods in Social Work

The various social work research methods have specific benefits and limitations determined by context. Common research methods include surveys, program evaluations, needs assessments, randomized controlled trials, descriptive studies and single-system designs.

Surveys involve a hypothesis and a series of questions in order to test that hypothesis. Social work researchers will send out a survey, receive responses, aggregate the results, analyze the data, and form conclusions based on trends.

Surveys are one of the most common research methods social workers use — and for good reason. They tend to be relatively simple and are usually affordable. However, surveys generally require large participant groups, and self-reports from survey respondents are not always reliable.

Program Evaluations

Social workers ally with all sorts of programs: after-school programs, government initiatives, nonprofit projects and private programs, for example.

Crucially, social workers must evaluate a program’s effectiveness in order to determine whether the program is meeting its goals and what improvements can be made to better serve the program’s target population.

Evidence-based programming helps everyone save money and time, and comparing programs with one another can help social workers make decisions about how to structure new initiatives. Evaluating programs becomes complicated, however, when programs have multiple goal metrics, some of which may be vague or difficult to assess (e.g., “we aim to promote the well-being of our community”).

Needs Assessments

Social workers use needs assessments to identify services and necessities that a population lacks access to.

Common social work populations that researchers may perform needs assessments on include:

• People in a specific income group
• Everyone in a specific geographic region
• A specific ethnic group
• People in a specific age group

In the field, a social worker may use a combination of methods (e.g., surveys and descriptive studies) to learn more about a specific population or program. Social workers look for gaps between the actual context and a population’s or individual’s “wants” or desires.

For example, a social worker could conduct a needs assessment with an individual with cancer trying to navigate the complex medical-industrial system. The social worker may ask the client questions about the number of hours they spend scheduling doctor’s appointments, commuting and managing their many medications. After learning more about the specific client needs, the social worker can identify opportunities for improvements in an updated care plan.

In policy and program development, social workers conduct needs assessments to determine where and how to effect change on a much larger scale. Integral to social work at all levels, needs assessments reveal crucial information about a population’s needs to researchers, policymakers and other stakeholders. Needs assessments may fall short, however, in revealing the root causes of those needs (e.g., structural racism).

Randomized Controlled Trials

Randomized controlled trials are studies in which a randomly selected group is subjected to a variable (e.g., a specific stimulus or treatment) and a control group is not. Social workers then measure and compare the results of the randomized group with the control group in order to glean insights about the effectiveness of a particular intervention or treatment.

Randomized controlled trials are easily reproducible and highly measurable. They’re useful when results are easily quantifiable. However, this method is less helpful when results are not easily quantifiable (i.e., when rich data such as narratives and on-the-ground observations are needed).

Descriptive Studies

Descriptive studies immerse the researcher in another context or culture to study specific participant practices or ways of living. Descriptive studies, including descriptive ethnographic studies, may overlap with and include other research methods:

• Informant interviews
• Census data
• Observation

By using descriptive studies, researchers may glean a richer, deeper understanding of a nuanced culture or group on-site. The main limitations of this research method are that it tends to be time-consuming and expensive.

Single-System Designs

Unlike most medical studies, which involve testing a drug or treatment on two groups — an experimental group that receives the drug/treatment and a control group that does not — single-system designs allow researchers to study just one group (e.g., an individual or family).

Single-system designs typically entail studying a single group over a long period of time and may involve assessing the group’s response to multiple variables.

For example, consider a study on how media consumption affects a person’s mood. One way to test a hypothesis that consuming media correlates with low mood would be to observe two groups: a control group (no media) and an experimental group (two hours of media per day). When employing a single-system design, however, researchers would observe a single participant as they watch two hours of media per day for one week and then four hours per day of media the next week.

These designs allow researchers to test multiple variables over a longer period of time. However, similar to descriptive studies, single-system designs can be fairly time-consuming and costly.

Learn More About Social Work Research Methods

Social workers have the opportunity to improve the social environment by advocating for the vulnerable — including children, older adults and people with disabilities — and facilitating and developing resources and programs.

Learn more about how you can earn your  Master of Social Work online at Virginia Commonwealth University . The highest-ranking school of social work in Virginia, VCU has a wide range of courses online. That means students can earn their degrees with the flexibility of learning at home. Learn more about how you can take your career in social work further with VCU.

From M.S.W. to LCSW: Understanding Your Career Path as a Social Worker

How Palliative Care Social Workers Support Patients With Terminal Illnesses

How to Become a Social Worker in Health Care

Gov.uk, Mixed Methods Study

MVS Open Press, Foundations of Social Work Research

Open Social Work Education, Scientific Inquiry in Social Work

Open Social Work, Graduate Research Methods in Social Work: A Project-Based Approach

Routledge, Research for Social Workers: An Introduction to Methods

SAGE Publications, Research Methods for Social Work: A Problem-Based Approach

Theory and Society, Mixed Methods Research: What It Is and What It Could Be

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The link between social work research and practice

When thinking about social work, some may consider the field to solely focus on clinical interventions with individuals or groups.

There may be a mistaken impression that research is not a part of the social work profession. This is completely false. Rather, the two have been and will continue to need to be intertwined.

This guide covers why social workers should care about research, how both social work practice and social work research influence and guide each other, how to build research skills both as a student and as a professional working in the field, and the benefits of being a social worker with strong research skills. 

A selection of social work research jobs are also discussed.  

• Social workers and research
• Evidence-based practice
• Practice and research
• Research and practice
• Build research skills
• Social worker as researcher
• Benefits of research skills
• Research jobs

Why should social workers care about research?

Sometimes it may seem as though social work practice and social work research are two separate tracks running parallel to each other – they both seek to improve the lives of clients, families and communities, but they don’t interact. This is not the way it is supposed to work.

Research and practice should be intertwined, with each affecting the other and improving processes on both ends, so that it leads to better outcomes for the population we’re serving.

Section 5 of the NASW Social Work Code of Ethics is focused on social workers’ ethical responsibilities to the social work profession. There are two areas in which research is mentioned in upholding our ethical obligations: for the integrity of the profession (section 5.01) and for evaluation and research (section 5.02). 

Some of the specific guidance provided around research and social work include:

• 5.01(b): …Social workers should protect, enhance, and improve the integrity of the profession through appropriate study and research, active discussion, and responsible criticism of the profession.
• 5.01(d): Social workers should contribute to the knowledge base of social work and share with colleagues their knowledge related to practice, research, and ethics…
• 5.02(a) Social workers should monitor and evaluate policies, the implementation of programs, and practice interventions.
• 5.02(b) Social workers should promote and facilitate evaluation and research to contribute to the development of knowledge.
• 5.02(c) Social workers should critically examine and keep current with emerging knowledge relevant to social work and fully use evaluation and research evidence in their professional practice.
• 5.02(q) Social workers should educate themselves, their students, and their colleagues about responsible research practices.

Evidence-based practice and evidence-based treatment

In order to strengthen the profession and determine that the interventions we are providing are, in fact, effective, we must conduct research. When research and practice are intertwined, this leads practitioners to develop evidence-based practice (EBP) and evidence-based treatment (EBT).

Evidence-based practice is, according to The National Association of Social Workers (NASW) , a process involving creating an answerable question based on a client or organizational need, locating the best available evidence to answer the question, evaluating the quality of the evidence as well as its applicability, applying the evidence, and evaluating the effectiveness and efficiency of the solution. 

Evidence-based treatment is any practice that has been established as effective through scientific research according to a set of explicit criteria (Drake et al., 2001). These are interventions that, when applied consistently, routinely produce improved client outcomes. 

For example, Cognitive Behavioral Therapy (CBT) was one of a variety of interventions for those with anxiety disorders. Researchers wondered if CBT was better than other intervention options in producing positive, consistent results for clients.

So research was conducted comparing multiple types of interventions, and the evidence (research results) demonstrated that CBT was the best intervention.

The anecdotal evidence from practice combined with research evidence determined that CBT should become the standard treatment for those diagnosed with anxiety. Now more social workers are getting trained in CBT methods in order to offer this as a treatment option to their clients.

How does social work practice affect research?

Social work practice provides the context and content for research. For example, agency staff was concerned about the lack of nutritional food in their service area, and heard from clients that it was too hard to get to a grocery store with a variety of foods, because they didn’t have transportation, or public transit took too long. 

So the agency applied for and received a grant to start a farmer’s market in their community, an urban area that was considered a food desert. This program accepted their state’s version of food stamps as a payment option for the items sold at the farmer’s market.

The agency used their passenger van to provide free transportation to and from the farmer’s market for those living more than four blocks from the market location.

The local university also had a booth each week at the market with nursing and medical students checking blood pressure and providing referrals to community agencies that could assist with medical needs. The agency was excited to improve the health of its clients by offering this program.

But how does the granting foundation know if this was a good use of their money? This is where research and evaluation comes in. Research could gather data to answer a number of questions. Here is but a small sample:

• How many community members visited each week and purchased fruits and vegetables? 
• How many took advantage of the transportation provided, and how many walked to the market? 
• How many took advantage of the blood pressure checks? Were improvements seen in those numbers for those having repeat blood pressure readings throughout the market season? 
• How much did the self-reported fruit and vegetable intake increase for customers? 
• What barriers did community members report in visiting and buying food from the market (prices too high? Inconvenient hours?)
• Do community members want the program to continue next year?
• Was the program cost-effective, or did it waste money by paying for a driver and for gasoline to offer free transportation that wasn’t utilized? What are areas where money could be saved without compromising the quality of the program?
• What else needs to be included in this program to help improve the health of community members?

How does research affect social work practice?

Research can guide practice to implement proven strategies. It can also ask the ‘what if’ or ‘how about’ questions that can open doors for new, innovative interventions to be developed (and then research the effectiveness of those interventions).

Engel and Schutt (2017) describe four categories of research used in social work:

• Descriptive research is research in which social phenomena are defined and described. A descriptive research question would be ‘How many homeless women with substance use disorder live in the metro area?’
• Exploratory research seeks to find out how people get along in the setting under question, what meanings they give to their actions, and what issues concern them. An example research question would be ‘What are the barriers to homeless women with substance use disorder receiving treatment services?’
• Explanatory research seeks to identify causes and effects of social phenomena. It can be used to rule out other explanations for findings and show how two events are related to each other.  An explanatory research question would be ‘Why do women with substance use disorder become homeless?’
• Evaluation research describes or identifies the impact of social programs and policies. This type of research question could be ‘How effective was XYZ treatment-first program that combined housing and required drug/alcohol abstinence in keeping women with substance use disorder in stable housing 2 years after the program ended?’

Each of the above types of research can answer important questions about the population, setting or intervention being provided. This can help practitioners determine which option is most effective or cost-efficient or that clients are most likely to adhere to. In turn, this data allows social workers to make informed choices on what to keep in their practice, and what needs changing. 

How to build research skills while in school

There are a number of ways to build research skills while a student.  BSW and MSW programs require a research course, but there are other ways to develop these skills beyond a single class:

• Volunteer to help a professor working in an area of interest. Professors are often excited to share their knowledge and receive extra assistance from students with similar interests.
• Participate in student research projects where you’re the subject. These are most often found in psychology departments. You can learn a lot about the informed consent process and how data is collected by volunteering as a research participant.  Many of these studies also pay a small amount, so it’s an easy way to earn a bit of extra money while you’re on campus. 
• Create an independent study research project as an elective and work with a professor who is an expert in an area you’re interested in.  You’d design a research study, collect the data, analyze it, and write a report or possibly even an article you can submit to an academic journal.
• Some practicum programs will have you complete a small evaluation project or assist with a larger research project as part of your field education hours. 
• In MSW programs, some professors hire students to conduct interviews or enter data on their funded research projects. This could be a good part time job while in school.
• Research assistant positions are more common in MSW programs, and these pay for some or all your tuition in exchange for working a set number of hours per week on a funded research project.

How to build research skills while working as a social worker

Social service agencies are often understaffed, with more projects to complete than there are people to complete them.

Taking the initiative to volunteer to survey clients about what they want and need, conduct an evaluation on a program, or seeing if there is data that has been previously collected but not analyzed and review that data and write up a report can help you stand out from your peers, be appreciated by management and other staff, and may even lead to a raise, a promotion, or even new job opportunities because of the skills you’ve developed.

Benefits of being a social worker with strong research skills

Social workers with strong research skills can have the opportunity to work on various projects, and at higher levels of responsibility. 

Many can be promoted into administration level positions after demonstrating they understand how to conduct, interpret and report research findings and apply those findings to improving the agency and their programs.

There’s also a level of confidence knowing you’re implementing proven strategies with your clients. 

Social work research jobs

There are a number of ways in which you can blend interests in social work and research. A quick search on Glassdoor.com and Indeed.com retrieved the following positions related to social work research:

• Research Coordinator on a clinical trial offering psychosocial supportive interventions and non-addictive pain treatments to minimize opioid use for pain.
• Senior Research Associate leading and overseeing research on a suite of projects offered in housing, mental health and corrections.
• Research Fellow in a school of social work
• Project Policy Analyst for large health organization
• Health Educator/Research Specialist to implement and evaluate cancer prevention and screening programs for a health department
• Research Interventionist providing Cognitive Behavioral Therapy for insomnia patients participating in a clinical trial
• Research Associate for Child Care and Early Education
• Social Services Data Researcher for an organization serving adults with disabilities.
• Director of Community Health Equity Research Programs evaluating health disparities.

No matter your population or area of interest, you’d likely be able to find a position that integrated research and social work. 

Social work practice and research are and should remain intertwined. This is the only way we can know what questions to ask about the programs and services we are providing, and ensure our interventions are effective. 

There are many opportunities to develop research skills while in school and while working in the field, and these skills can lead to some interesting positions that can make a real difference to clients, families and communities. 

Drake, R. E., Goldman, H., Leff, H. S., Lehman, A. F., Dixon, L., Mueser, K. T., et al. (2001). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services, 52(2), 179-182. 

Engel, R.J., & Schutt, R.K. (2017). The Practice of Research in Social Work. Sage.

National Association of Social Workers. (n.d). Evidence Based Practice. Retrieved from: https://www.socialworkers.org/News/Research-Data/Social-Work-Policy-Research/Evidence-Based-Practice

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Social Work Research and Evaluation Foundations

Studying social work and its effect on societies is essential to understanding and enhancing human and community well-being. By effectively measuring and evaluating social work outcomes, practitioners can employ evidence-based social work practices and evidence-based treatments (EBTs) to provide structured approaches to addressing client needs. For example, in the case of a client with an anxiety disorder, cognitive behavioral therapy (CBT) and behavioral science can be applied as efficient and ethical frameworks to address communication and collaboration problems. 1

Read on to learn more about the essential role of social work research and evaluation.

The Importance of Research and Evaluation in Social Work Practice

By rigorously assessing and evaluating social work studies, researchers can better identify the most effective strategies to achieve their client’s objectives. 2 Instead of trial and error, a data-driven approach ensures researchers make better use of the resources available to them.

Evidence-based interventions result from analyzing past research findings. After choosing a solution, researchers test it to verify replicability in multiple real-world scenarios before it’s deemed successful. 3 New intervention methods are constantly being standardized across the social work field of study, letting practitioners choose from a wider range of tools and techniques suitable for their study. These are usually taught in more advanced research courses in graduate or master's programs.

For example, at Wurzweiler School of Social Work, students participate in individual research projects and learn the basics of conducting social work research . This includes learning how to use measurement instruments; logic of research design, including sampling and design selection; ethical and legal issues; quantitative and qualitative modes of observation; analysis of data; use of computers and computer programs; and research report writing.

Methodologies and Approaches for Conducting Social Work Research

Conducting social work research requires access to large amounts of data supplied by study participants, which can be historical data or up-to-date surveys. 4 Due to social work’s multifaceted nature, researchers must then use their understanding of how psychosocial factors intersect. They need to develop and adhere to strict research methodologies that are evidence-based instead of preconceived notions of a particular social issue. 5

Action Research and Participatory-Action Research (PAR)

By emphasizing the importance of direct collaboration with communities, researchers can hope to identify and address a demographic’s needs. 6

Empowerment Research

Studies, surveys and experiments aim to increase the feelings of empowerment, equality and social justice among people in communities by having them participate directly in the research process. 7

Constructivist Research

Constructivist research begins with the individual and their social contexts instead of the community as a whole. 8 It highlights the importance of perspective and social standing in shaping communities .

Designing Effective Evaluation Frameworks for Social Programs

Data collected from participants in a target demographic is considered raw data that needs to go through several stages of cleaning and refining before any insights can be extracted. 9 That’s why researchers need to be able to develop robust evaluation frameworks that facilitate access to the data.

Logic Models

Logic models are often used to evaluate a single program or intervention. 10 Logic models are designed to offer:

• Development approaches: Using forward logic to develop models starts from activities to predict outcomes, or vice versa in the case of reverse logic
• Framework utility: Frameworks guide the implementation and reporting of the logic model by clarifying its methodology and expected results
• Visual representation: Graphical depictions of data illustrate the connections between a study’s input, activities and outputs, showcasing the anticipated outcomes
• Components: Key elements include the problem statement, outcomes, outputs, resources and strategies

Theories of Change and Program Theory

Merging theories with logic models adds depth to frameworks by outlining the research process, mechanisms and the logic behind the expected outcomes. 11 Furthermore, theories explain the “how” and “why” the desired changes and outcomes are expected to occur in the program’s context, including factors outside the program’s control.

Furthermore, leveraging resources such as The Kellogg Foundation Logic Model Development Guide and the CDC Framework for Program Evaluation in Social Work can offer guidance and tools for constructing and utilizing robust evaluation frameworks. 12,13

Data Collection and Analysis Techniques in Social Work Research

Researchers can collect relevant data in a variety of ways , such as surveys, in-person focus groups, observations and official census reports. They can then select the suitable social work data analysis technique based on the type of data they have and the nature of the insights they’re looking for. 14 These techniques include:

• Thematic analysis: A qualitative approach that identifies, analyzes and reports patterns and anomalies
• Descriptive statistics: Mean, medians, modes and averages of datasets
• Inferential statistics: Predictive models that provide insights based on patterns

Ethical Considerations in Social Work Research and Evaluation

Ethical considerations determine the efficacy of social work research methods and evaluations. 15 Participants in the study must give informed consent to the data being collected on them without attempts to persuade or influence their answers. 16 Similarly, confidentiality and anonymity, especially when handling socially sensitive topics, are needed to ensure candid responses from study participants.

Utilizing Research Findings to Inform Evidence-Based Practice

In order to use results from past studies to inform future practices, researchers need to translate the studies’ outcomes through systematic reviews and guideline development. 17 The outcomes of earlier implementations often require constant monitoring to detect any underlying biases that can be addressed early on.

Challenges and Limitations in Social Work Research and Evaluation

Research in social work often faces numerous challenges that might impact the quality and efficacy of studies. Some of the most common ones include:

• Time constraints
• Hard-to-reach populations
• Inadequate strategies
• Financial constraints

Case Study of Successful Research and Evaluation Initiative

Despite the many complexities, many research studies can be successfully conducted in the field of social studies. One example is the study of developing new treatments for post-traumatic stress disorder (PTSD) patients.

First developed in the 1980s by Francine Shapiro, eye movement desensitization and reprocessing has been successful in treating emotional distress associated with PTSD. The method’s application was then expanded to include a wide range of issues from trauma and anxiety to addiction.

It’s been supported by over 30 controlled outcomes studies and has since been recognized by the World Health Organization and the Department of Veterans Affairs (VA) as an effective therapeutic method. 18

Deepen Your Impact Through Social Work

The intersection between theoretical research and practical evaluation in the field of social work produces solutions that make a profound impact on the quality of life of communities and individuals. 19 This is a testament to the commitment of researchers to advance the field through progressively available means, particularly technology for data collection and mathematical algorithms for Big Data analytics.

Yeshiva University’s online Master of Social Work focuses on cultural responsiveness, social justice, and human transformation. You will gain hands-on experience in the field of social work and obtain CSWE accreditation that qualifies you for the post-graduate state exam. The expert faculty will equip you with the tools to create positive change in the world. Make an appointment to speak with an admissions outreach advisor today.

• Retrieved on April 10, 2024, from hbr.org/podcast/2021/01/using-behavioral-science-to-improve-well-being-for-social-workers
• Retrieved on April 10, 2024, from researchgate.net/publication/323370072_Evaluating_effectiveness_in_social_work_sharing_dilemmas_in_practice
• Retrieved on April 10, 2024, from ncbi.nlm.nih.gov/books/NBK547524/
• Retrieved on April 10, 2024, from researchgate.net/publication/298697140_Big_data_in_social_work_The_development_of_a_critical_perspective_on_social_work’s_latest_electronic_turn
• Retrieved on April 10, 2024, from https://caseworthy.com/articles/why-is-evidence-based-practice-important-in-social-work/
• Retrieved on April 10, 2024, from nature.com/articles/s43586-023-00214-1
• Retrieved on April 10, 2024, from academic.oup.com/bjsw/article/51/4/1482/6202975
• Retrieved on April 10, 2024, from journals.sagepub.com/doi/full/10.1177/16094069231186257
• Retrieved on April 10, 2024, from journals.sagepub.com/doi/10.1177/17456916221137350
• Retrieved on April 10, 2024, from sopact.com/guides/theory-of-change-vs-logic-model
• Retrieved on April 10, 2024, from betterevaluation.org/frameworks-guides/rainbow-framework/define/develop-programme-theory-theory-change
• Retrieved on April 10, 2024, from naccho.org/uploads/downloadable-resources/Programs/Public-Health-Infrastructure/KelloggLogicModelGuide_161122_162808.pdffrom-being-a-breeding-ground-for-threats/
• Retrieved on April 10, 2024, from cdc.gov/evaluation/framework/index.htm
• Retrieved on April 10, 2024, from nesta.org.uk/feature/eight-ways-councils-are-using-data-create-better-services/the-data-driven-social-worker/
• Retrieved on April 10, 2024, from cmsindia.org/sites/myfiles/Guidelines-for-Ethical-Considerations-in-Social-Research-Evaluation-In-India_2020.pdf
• Retrieved on April 10, 2024, from researchsupport.admin.ox.ac.uk/governance/ethics/resources/consent
• Retrieved on April 10, 2024, from health-policy-systems.biomedcentral.com/articles/10.1186/s12961-020-00662-1
• Retrieved on April 10, 2024, from ptsd.va.gov/understand_tx/emdr.asp
• Retrieved on April 10, 2024, from researchgate.net/publication/8480043_Future_directions_in_evaluation_research_People_organizational_and_social_issues

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The Loneliness of Working for Social Change

People at the forefront of social change often feel unsupported and alone..

Updated April 19, 2024 | Reviewed by Kaja Perina

• Understanding Loneliness
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• Why is it so difficult for leaders to develop close relationships with the people they lead?
• How can leaders form close, meaningful relationships outside of work?
• What do social change leaders most need from others to feel they are not "in it on their own"?

Ever since Sarah Wright and I started researching loneliness together about ten years ago, I have asked participants at my leadership conferences “Who here feels lonely sometimes?” at the beginning of a session I teach on how to create a culture of belongingness in organizations. A decade ago, about 15 percent of people would self-consciously raise their hands.

Loneliness and Leading Social Change

My heart sank a few weeks ago in Amsterdam, where I was teaching a leadership program to 53 nonprofit leaders, when ninety percent of hands were raised in response to this question.

Is this because we are lonelier, or because loneliness has become less stigmatized? Clearly, loneliness is skyrocketing: 58 percent of Americans are lonely post-pandemic and Ministers for Loneliness have been appointed in the UK (on the heels of a study that found that British children spend less time outside than prison inmates ) and Japan. Likely, it is both.

One thing is clear: social change leaders are suffering. In some nonprofit organizations, board members volunteer their time but are reluctant to give financially to the organization.

Show Us the Money

Considering that nonprofit staff require money to show up at work, materials for beneficiaries require money to purchase and offices require money to rent, this lack of financial (rather than volunteer) willingness can result in nonprofit leaders feeling they are out on a limb, alone.

Such leaders feel they are barely able to keep their organizations afloat, especially if they don’t want to depend solely on government funding so they can pursue a social mission untainted by its expectations and requirements.

In other organizations, board members write a check to ease their conscience each year but are not willing to donate their precious time. Just as board members who don’t show up to meetings can leave nonprofit leaders feeling unsupported and lonely, board members who refuse to add revenues to the organizational budget can exacerbate the loneliness that nonprofit leaders experience.

Are You My Friend?

As part of our evidence-based leadership approach, in a survey the social change leaders completed for a study I am conducting with Juliana Schroeder at the University of California Berkeley and other researchers, an early finding we presented at the conference is that leaders think they are better friends with subordinates than vice-versa.

The social needs of nonprofit leaders, it seems, are heavier as they work so many hours that they have little time to develop non-work friendships.

Why is it so challenging for social change leaders to form close, meaningful relationships within their organizations? Because they have to lead these people. As is the case for leaders in the private or public sectors, it is difficult for them to truly share their challenges and concerns with either their board members or staff, who may perceive them as weak if they do.

“Within your organization, you really can’t talk to your staff,” one nonprofit leader shared, “and you don’t want to talk to other board members about problems that you wouldn’t talk to your board chair about.”

If you do talk with other board members about challenges in the organization, he confided, the problem is that “are you going to try to start a coup and try to overthrow the board chair? Are you going to go to someone else on your staff and then you’re going to bring down morale within the organization?”

For socioemotional support, many social change leaders feel stuck. What, then, can they do to fulfill their need for close relationships?

Finding Solutions

Other nonprofit leaders, rather than their staff or board members, may be the ideal people with whom they can develop relationships. The importance of peer relationships is central to one of the leadership principles I teach to leaders in the nonprofit, private and public sectors: “It’s Easier to Be a Friendly Leader than to Be a Friend and a Leader.”

How can we help as board members of such organizations to support our social change leaders? When we dedicate both our time and a financial contribution that is meaningful to us, the leaders of these organizations are less likely to feel they are in it on their own.

That, along with forming peer relationships with other social change leaders outside of their organization, will help them feel less isolated. Given the detrimental physical and mental health outcomes associated with loneliness , that means a lot.

Anthony Silard, Ph.D., is an Associate Professor of Leadership and the Director of the Center for Sustainable Leadership at Luiss Business School in Rome, and the Distinguished Visiting Professor of Leadership at Tecnológico de Monterrey.

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Health Equity

Parents Want Providers to Log Their Children’s Social Needs but with Transparency and Respect

Parents also fear disclosing social needs will lead to child welfare referrals, a study by ldi fellows finds.

• Miles Meline, MBE
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Yes [social needs information belongs in the chart]. I feel like that’s good to know. I feel like if it something that you need help with or anything, I feel like it should be in the chart because it’ll give you a better sense of who that person is or what type of environment they in… – Participating parent on health-related social needs

When children go to a pediatrician appointment, caregivers need to understand the social problems that their young patients are experiencing. Are they in stable housing? Do they have access to enough food? Are they safe? 

Collecting these health-related social needs (HRSNs) benefits patients and providers, but the patient-clinician relationship involves a third key partner—the patient’s parents, guardians, or caregivers. 

Eager to learn the perspectives of parents on HRSN screening and data collection, Children’s Hospital of Philadelphia (CHOP) PolicyLab Faculty Scholar Zoe Bouchelle , LDI Senior Fellows Aditi Vasan , Chén C. Kenyon , and colleagues conducted 20 semi-structured interviews with parents of hospitalized children participating in an HRSN screening program at a prominent children’s hospital. 

The study is among the first to examine parent perspectives on International Classification of Diseases 10th Revision (ICD-10) Z codes , which provide categories to identify nonmedical factors (i.e., HRSNs) such as housing, transportation, and the presence of violence that may influence a patient’s health status.

The participating parents were all female with 55% identifying as Black or African American and 20% as Hispanic or Latino. Parents expressed comfort with sharing HRSN information with their children’s providers, but asked for more transparency around HRSN data sharing and respect of parental preferences. Many raised concerns about documentation and sharing of HRSN data that could lead to unwanted disclosures, such as those that could trigger child welfare referrals.

Most parents cited social workers and medical teams as the most appropriate recipients of HRSN data, while few parents felt comfortable with HRSN data being shared with insurers.  

According to co-investigator Vasan, understanding parent perspectives on HRSN screening is key because caregivers often have to navigate complex, inefficient systems to access the social service programs and community-based resources their families need. “The time and resources that parents and other caregivers spend figuring out how to receive Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Medicaid, or Supplemental Security Income (SSI) benefits for their children can take away from their ability to care for these children and support their health and well-being,” Vasan said. “That’s why it’s so important to design family-centered programs that assess and address families’ HRSNs in a way that is consistent with their preferences and that ensures they can receive support tailored to their needs.” 

As the U.S. health system works to reduce persistent social inequities and disparities in health outcomes, providers and insurers can build trust by providing transparency around documentation and data sharing with families.

To learn more about the study and its policy implications, we asked lead and senior authors Bouchelle and Kenyon a series of questions below.

What kinds of HRSN data might be gathered during a pediatric visit, and how are they collected?

Bouchelle : Health-related social needs are social and economic risk factors that can affect health and determine which families would like help. HRSN data collected during a child’s visit might include things like unstable housing, inadequate access to food, challenges with transportation, difficulty paying utilities, or intimate partner violence. Often, HRSN data are collected through conversations with families through a questionnaire, on paper or electronically.

What are some issues with HRSN data collection?

Bouchelle : I’ll highlight a few.

First, even though the American Academy of Pediatrics (AAP) recommends that pediatric providers routinely screen for HRSNs, no standard recommendations exist for the collection, documentation, and sharing of HRSN data. This leads to variation in practice.

Second, HRSN screening can probe sensitive areas of families’ lives. If not done in alignment with parents’ expectations, HRSN screening, documentation, and data sharing could create mistrust between families and their children’s providers.

Third, we just don’t have a lot of data examining parents’ beliefs, expectations, and preferences about how HRSN data are documented and shared. That information is important to ensure the data we collect are used to maximize benefit and minimize unintended negative consequences for families.

What inspired you to examine parents’ preferences about how HRSN data are documented and shared?

Bouchelle : Currently, there’s a lot of interest in and momentum around HRSN screening in pediatrics. Some of that enthusiasm comes from a desire to address contributors to poor health with upstream interventions. But a big chunk of it also comes from incentives from regulators and insurers, like the Centers for Medicare & Medicaid Services, the Joint Commission, and Medicaid. I worry that without understanding parents’ preferences, it could result in creating programs that check the regulators’ and payers’ boxes but do so in a way that doesn’t help families, or could even harm some of them.

What were your most important findings?

Bouchelle : One thing we found was that most parents were comfortable with the documentation of HRSN data in their child’s health record, but only if the information was used to provide them with meaningful support. This suggests that we may not want to ask these questions if we don’t have any real support to provide.

Another takeaway is that most parents felt social workers and medical teams should have access to HRSN data, but few parents felt comfortable with HRSN data being shared with their insurers. We should think long and hard about if, how, and why this information is shared with health insurers.

Some parents worry about the information being weaponized against them. What is needed to avoid that?

Bouchelle : Some parents had concerns that sharing of HRSN data may put them at risk for referrals to child protective services. This is a valid concern, and one I share with parents.

We need to be more transparent with families about why we collect this information and who will have access to it. We also need to create systems that can track if there are increases in referrals to child protective services from screening.

Where are you going next with this line of research?

Bouchelle : We’re working on a paper that will help share our team’s process of creating an HRSN screening program at CHOP. It will highlight some of the ways we’ve changed the program in response to parents’ concerns about documentation and data sharing. I hope that this will spur other institutions to critically evaluate their processes, but also share with us what they’ve learned.

How are HRSN data currently being used in pediatric settings?

Kenyon : HRSN data are not used in a uniform way. Some institutions may provide families with a link to community resources, some may provide personalized information based on social needs, while others may involve ad hoc referrals to social work or community health worker programs. The type of response depends on several factors including whether there are policies and personnel involved in implementing social needs screening, the availability of resources in the community, and whether there are staff to respond to individual families’ needs.

How can health systems be transparent around documentation and data sharing with families?

Kenyon : Health systems can invest in educating staff on how to communicate with families about documentation in health records. For institutions at which screening occurs electronically, they should consider including an introduction to the questions that states the reasons for collecting the data,  where the data will be stored, and with whom it will be shared.

Families worried about insurers accessing the data, but insurers may be the funders of the HRSN services the family needs. Are there ways to navigate this?

Kenyon : This will be challenging. Something that emerged from the interviews was that families did not understand why insurers should receive social needs information if they did not have resources to provide for the family. In other words, why did insurers need to know sensitive social information if they weren’t capable of doing anything to help? This concern may be somewhat mitigated as insurers increasingly provide support to address social needs like delivered meals, housing assistance, and transportation assistance. But it is an important consideration, particularly with government payers who are incentivizing screening for HRSNs.

What recommendations do you have for hospital leaders, insurers, and policymakers?

Kenyon : Hospital leaders who use electronic health records should consider collaborating with clinical informaticists to address potential vulnerabilities in data documentation and sharing. For payers, more work needs to be done to understand the acceptability—and effectiveness—of insurers engaging in social care interventions. Policymakers should consider incentives that reimburse not only for screening, but for successfully connecting families to relevant programs closely linked to favorable outcomes.

The study, “ Parent Perspectives on Documentation and Sharing of Health-Related Social Needs Data ,” was published on March 13, 2024 in Hospital Pediatrics . Authors include Zoe Bouchelle, Stephanie G. Menko, Mishaal Yazdani, Aditi Vasan , Philip Scribano, Judy A. Shea, and Chén C. Kenyon .

Policy Coordinator

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• Open access
• Published: 09 May 2024

Getting an outsider’s perspective - sick-listed workers’ experiences with early follow-up sessions in the return to work process: a qualitative interview study

• Martin Inge Standal 1 , 2 ,
• Vegard Stolsmo Foldal 1 ,
• Lene Aasdahl 1 , 3 ,
• Egil A. Fors 1 &
• Marit Solbjør 1  

BMC Health Services Research volume  24 , Article number:  609 ( 2024 ) Cite this article

Metrics details

The aim of this study was to explore how early follow-up sessions (after 14 and 16 weeks of sick leave) with social insurance caseworkers was experienced by sick-listed workers, and how these sessions influenced their return-to-work process.

A qualitative interview study with sick-listed workers who completed two early follow-up sessions with caseworkers from the Norwegian Labor and Welfare Administration (NAV). Twenty-six individuals aged 30 to 60 years with a sick leave status of 50–100% participated in semi-structured interviews. The data was analyzed with thematic analysis.

Participants’ experiences of the early follow-up sessions could be categorized into three themes: (1) Getting an outsider’s perspective, (2) enhanced understanding of the framework for long term sick-leave, and (3) the empathic and personal face of the social insurance system. Meeting a caseworker enabled an outsider perspective that promoted critical reflection and calibration of their thoughts. This was experienced as a useful addition to the support many received from their informal network, such as friends, family, and co-workers. The meetings also enabled a greater understanding of their rights and duties, possibilities, and limitations regarding welfare benefits, while also displaying an unexpected empathic and understanding perspective from those working in the social insurance system.

For sick-listed individuals, receiving an early follow-up session from social insurance caseworkers was a positive experience that enhanced their understanding of their situation, and promoted reflection towards RTW. Thus, from the perspective of the sick-listed workers, early sessions with social insurance caseworkers could be a useful addition to the overall sickness absence follow-up.

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Introduction

Returning to work (RTW) from long-term sick leave is a complex and multifaceted process [ 1 ]. Prolonged sick leave has been linked to poorer health [ 2 ] and is thought to increase the psychosocial obstacles for RTW [ 3 ]. Therefore, early RTW interventions have been suggested to be central to the RTW-process [ 3 ]. Long-term sickness absence is often understood as sick-leave beyond 4–8 weeks of work absence. Most workers return to work on their own within the first few months of absence [ 4 ] and interventions in the following weeks, can improve the likelihood of RTW for those remaining [ 5 , 6 , 7 , 8 ]. Furthermore, in the context of long-term sick leave, interventions contributing to earlier RTW can be highly cost-effective [ 9 , 10 ].

In Norway, the responsibility of early sick-leave follow-up is shared between the general practitioner (GP), who certify sick leave and assess remaining work capabilities, and the employer who should make accommodations at the workplace to facilitate RTW [ 11 ]. The employer has the main responsibility to assist their employees back to work but many employers lack the resources to properly facilitate RTW [ 12 ], and GPs may not see RTW as one of their primary focuses [ 13 ]. Thus, the existing system for early RTW follow-up in Norway, which largely rely on the cooperation between employer and employee, may not be sufficient to promote RTW [ 14 ]. This means that more effort to promote RTW might be needed. For instance, in other legislative systems RTW coordinators that assist other stakeholders and facilitate the RTW process are frequently used [ 15 , 16 ]. In Norway, there are no formal RTW coordinator roles, and the task of facilitating cooperation between stakeholders, such as the employer, healthcare services and the sick-listed, fall on social insurance caseworkers working in the Norwegian Labour and Welfare Administration (NAV). They have a counseling role in sickness absence follow-up by providing support for the employer and sick-listed worker, but they also act as a controller of eligibility for sickness benefits [ 17 ]. Ordinarily, there are few meeting points between the sick listed worker and their NAV caseworker, and most sick listed workers have their first meeting with NAV when they have been sick-listed for six months.

The impact of RTW coordinators is contested. A broad systematic review determined that RTW coordinators had little effect on RTW [ 18 ]. However, face-to-face meetings with RTW coordinators have also been shown to increase RTW rates [ 19 ]. Evidence from Norway suggest that meetings between NAV caseworkers, sick-listed individuals and other stakeholders at 26 weeks could be cost-beneficial for RTW [ 20 ]. Caseworkers reviewing possibilities and barriers to RTW has also been found to improve the caseworkers’ knowledge of the sick-listed’s situation and consequently improved RTW rates in the following months [ 21 ]. Social insurance caseworkers could thus be in a position to provide additional case-management and support in the earlier stages of sick leave. Researchers have also suggested that NAV should play a more active part in the earlier phases of long-term sick leave [ 22 ]. Similarly, caseworkers have also called for being involved earlier in the RTW process [ 23 ]. In their experience, the longer workers are on sick leave, the harder it is to facilitate RTW [ 14 ]. Moreover, sick-listed individuals in Norway also expect some form of NAV involvement in the early stage of long-term sick-leave [ 24 ].

In a recent study, sick-listed workers experienced that early follow-up sessions where NAV caseworkers used motivational interviewing helped normalize their situation and improved their beliefs in their RTW plan [ 25 ]. Given the extensive resources required to implement and adopt motivational interviewing in a social insurance setting [ 23 ], it is also useful to know how early additional follow-up sessions without a guided focus is experienced, and how they could fit within the standard follow-up for workers on long term sick-leave.

Thus, the aim of this study was to investigate how sick-listed workers experienced early additional follow-up sessions with NAV and how they experienced the influence of the sessions on their RTW process.

Materials and methods

The present study was based on 26 semi-structured individual interviews with sick-listed workers participating in a randomized controlled trial (RCT). The aim of the RCT was to evaluate the effect of motivational interviewing as an instrument for caseworkers at NAV in facilitating RTW for sick-listed workers [ 26 ]. The early follow-up sessions, which this paper focuses on served as an active control group.

The Norwegian welfare system and sickness absence follow-up

In Norway, employees are entitled to full wage benefits in the case of sickness absence, from the first day of absence to a maximum period of 52 weeks. Sick leave is in most cases certified by the individual’s general practitioner. During the first 16 days, the employer is responsible for the payment, while the rest is paid for by the National Insurance Scheme through NAV [ 27 ]. The employer must initiate a follow-up plan in cooperation with the employee before the end of the fourth week of sick leave and is responsible for arranging a meeting with the sick-listed worker within the seventh week of absence, including other stakeholders if relevant. If the employer facilitates work-related activities, the sick-listed worker is required to participate. NAV is responsible for arranging a meeting including the employer and the sick-listed worker at 26 weeks of sick leave. The attendance of the sick-listed worker’s GP is optional. However, the GP is obliged to attend if NAV deems it necessary for the coordination of the RTW process. This is the only obligatory meeting point between a sick listed worker and NAV. Additional meetings can also be held if one or more of the stakeholders find it necessary. Thus, the sick-listed worker may also ask for a meeting with NAV to coordinate a plan for RTW outside this schedule [ 27 ]. After 12 months of sick leave, it is possible to apply for the more long-term benefits, work assessment allowance and permanent disability pension.

The early follow-up sessions

The early follow-up sessions for this study were in addition to ordinary follow-up and consisted of two counseling sessions held at 14 and 16 weeks of sick leave. The sessions, offered by a NAV caseworker, lasted a maximum of 60 min and were in addition to standard NAV follow-up. During the first session, the caseworker opted to map out the sick-listed worker’s work situation, their relationship to their employer, their RTW plan, treatment plans and work ability, in addition to informing the sick-listed worker about their rights and duties as sick-listed. The caseworkers also informed about possible RTW measures through NAV. The second session focused on following up on the topics discussed in the first session, as well as focusing on any changes in the sick-listed workers’ situation that might have occurred between the first and second session.

These sessions functioned as an active control group in the RCT and were designed to be similar to the motivational interviewing sessions provided in terms of dose and timing. Caseworkers providing the active control sessions were separate from those providing the motivational interviewing sessions and they received no formal motivational interviewing training. They were, however, recruited voluntarily to the study from the same NAV-office as those performing the motivational interviewing sessions. Caseworkers were not randomized to group in the RCT and thus joined knowing that they would provide early follow-up using their usual methods.

Study population and recruitment

The study population consisted of sick-listed workers who were enrolled in the RCT. Eligible participants were sick listed workers aged 18–60 years old, living in central Norway, with any diagnoses. Their sick-leave status at the time of inclusion in the RCT were 50–100% for at least 8 weeks. Exclusion criteria were pregnancy-related sick-leave, unemployment, and being self-employed. To be eligible to participate in this interview study the sick-listed worker had to have been randomized to the active control group in the RCT and completed the early follow-up sessions. Eligible participants were identified by NAV and contact info was forwarded to the researchers. A member of the project group invited the participants to take part in the research interview by phone. A total of 40 individuals were invited to participate in the interview study, of which 14 did not answer, declined the invitation, or did not show up at the interview. Twenty-six individuals participated in the interviews, including 19 women and 7 men aged 31–61. Participants showed diversity in their self-reported reasons for being sick listed, with 11 having mental health disorders, 8 having musculoskeletal disorders, and 7 individuals reported other disorders.

Data collection

We conducted semi-structured individual interviews which allowed the participants to provide in-depth descriptions of their experiences. Interviews were based on an interview guide with five main questions concerning their experiences during sick leave, the RTW process, experiences of the two follow-up sessions, and whether these sessions led to any changes during their RTW process. The interviews were conducted between November 2018 and September 2019 and were audio recorded and transcribed verbatim. The duration of the interviews ranged from 35 min to 65 min.

Data analysis

For our data analysis, we used reflexive thematic analysis which is a method for identifying, analyzing, and reporting patterns within qualitative data [ 28 ]. Thematic analysis is a flexible approach which allows researchers to interpret the data through a six phased recursive process, moving back and forth between phases to build themes from codes. The first step of the analysis involved becoming familiar with the data [ 28 ] where transcripts of all interviews were read and re-read by authors VSF, MIS and MS to get an overall impression of the contents. Preliminary codes and patterns were identified, as a start of the coding process. The second step of the analysis was the coding process, where items of interest related to the aim were coded by author VSF. These codes were then used to create core categories for further development of initial themes [ 28 ]. The third step was combining the codes into initial themes, which is a data reducing process which allows interpretation from the researchers [ 28 ]. Initial themes were discussed among all authors. The fourth step was reviewing the generated themes and checking them against the coded data, in order to further expand or revise the developed themes [ 28 ]. When reviewing the generated themes against the coded data, the preliminary analysis indicated a tendency where participants who received good support and follow-up by their employer considered the early follow-up sessions by NAV as less useful than the participants who lacked support and follow-up by their employer. However, a coding of the interviews focusing on this aspect showed no clear tendency of favoring early follow-up sessions based on high or low employer support. Thus, the initial themes were further developed into the three main themes which will be presented below. All authors had several meetings to discuss, define and refine the final themes in order to tell a coherent and compelling story about the data [ 28 ].

All participants received written and oral information about the study and gave their written consent before the interview started. Participants were informed that participation was voluntary and that they could withdraw from the study at any time, if the data had not been anonymized and integrated in the analysis.

The study was approved by the Regional Committee for Medical and Health Research Ethics in Southeast Norway (No: 2016/2300).

Regarding receiving the two sessions, the participants had overall positive experiences with the content and timing of the first session. The second session, however, was frequently experienced as an unnecessary repetition of the first as much of the content was already covered. In the following we present our results of participants’ experience of the early follow-up sessions as three themes: (1) Getting an outsider’s perspective, (2) enhanced understanding of the framework for long term sick-leave, and (3) the empathic and personal faces of the social insurance system.

Getting an outsider’s perspective

Participants describe the meetings with a NAV caseworker as a positive experience that also challenged their current view of their situation and their RTW process. Meeting a NAV caseworker was experienced as an arena where they received guidance from an individual who examined their situation through an outsider’s perspective. NAV caseworkers provided support and encouragement, but also asked critical questions regarding their situation and their plans for RTW.

“… we talked primarily about my situation, and I felt like I was allowed to talk to someone unbiased, without you know, being limited in the conversation. And I felt like I could talk about those things important to me. […] it turned out to be a good dialogue where she pulled me further, and made me think about a couple of things” - Interview 3 .

The outside perspective was described as useful due to the participants’ context prior to the meeting, which was their everyday lives with friends, colleagues, family, GPs, and employers. This informal network was described as significant supporters during the sick leave and served an important role as confidants to whom the sick-listed worker could talk about their difficult or confusing situation. The formal support from the employer varied, where some experienced several supportive phone calls and meetings with the employer during their sick leave, while others had only had a single formal meeting. Having support from the employer was experienced as crucial for a good RTW process, and absence of support and a distant relationship to the employer led to a difficult RTW process with negative emotions and reduced belief in their RTW capabilities. Participants also experience that being able to talk freely with the employer could be difficult, and that they would be held accountable if confiding about difficulties in RTW. Thus, in contrast to the largely supportive informal network, and the restrained environment surrounding employer-support, meeting the NAV caseworkers provided a useful outside perspective. When describing the early sessions compared to their overall sick leave follow-up, participants described meeting NAV as a calibration of their thoughts and providing a new perspective compared to their other RTW supporters.

Enhanced understanding of the framework for long term sick leave

An important element of the first meeting was receiving information about rights, obligations as sick-listed, and the frame for future economic benefits. Receiving information about potential future loss of income and the possibility of having disability benefits was novel and useful for the participants. For some, this information led to new reflections on how being long-term sick-listed would have financial consequences, thereby providing another push for returning to work. For one participant, information about possible future loss of income provoked a feeling of panic and challenged her sense of identity.

“I remember that when he started talking about work assessment allowance, I panicked a bit. Because I couldn’t identify with that category. But at the same time, I thought, okay, it’s good information to have you know.” - Interview 2 .

Furthermore, the participants were happy with agenda of the first meeting where the NAV caseworkers focused on short-term, as well as long-term plans for RTW and gave personal feedback about participants’ RTW plan. Included in the short- and long-term focus was receiving information from NAV about available RTW measures and interventions. Whether the sick-listed workers were planning on a fast or slow paced RTW plan, they experienced that receiving support on their plans and ideas strengthened their beliefs in managing RTW. NAV caseworkers also presented different strategies relating to possible accommodations at work, such as adjusting workload, work tasks and working time. Information such as the possibility of adjusting their time spent at work and their sick-leave status enabled the sick-listed workers to reorient their perception towards returning to work.

“… in a way I hadn’t thought so carefully about when it’s smart to return and in what percentage. Because when I got that deal with the GP where I was still 100% sick-listed but could regulate it myself within 20% it was the first step to beginning to test myself.” - Interview 10 .

Participants received individually tailored information regarding the possibility of flexibility in the time spent at work and the amount of work they produced (i.e., sick leave percentage does not reflect hours spent at work, only the amount of work one does). This was highlighted as new and important information that was experienced as a contribution towards RTW.

The empathetic and personal face of the social insurance system

All study participants had taken part in two sessions with a caseworker from NAV. Prior to these sessions, NAV had been perceived as difficult to get in touch with and some feared that cooperation with NAV would be either difficult or absent. However, when meeting the NAV-caseworker, their fears were diminished and to their surprise, they were met by supportive, accommodating, and friendly caseworkers.

“NAV got a face; a personal face and NAV was no longer the huge colossus. The anonymous colossus that no one understands that just spews rules you have to relate to, which can be very … I can react with fear, I get afraid. “Am I doing this right?” you know. Am I following all these rules that I do not understand? What happened when NAV suddenly became a person was that they were on my side. They helped me, and it was possible to talk to NAV. A nice person helped me instead of rules that try to hinder me that I have to follow.” – Interview 19 .

The early follow-up sessions were experienced as more relevant when comparing them with other follow-up with their employer or later meetings with other caseworkers from NAV.

“I wished that the other later conversations and meetings [with NAV] was comprised of the same understanding and competence that this counselor had. So that is what I’m sitting here thinking, that this was a star example of how one should be met, you know.” – Interview 5 .

The positive experiences of the early follow-up session were due to the understanding atmosphere that was created by the caseworkers, who was perceived as genuinely interested in their situation, cooperative and jointly reflecting about their RTW plan. Caseworkers asked questions about aspects of the participants’ lives that could be related to their situation as a sick-listed worker, and they appeared attentive when listening. This led to the experience of being met as a whole person and contributed to the early follow-up sessions being experienced as an arena where they felt acknowledged and cared for.

“So, I came to NAV in high spirits and was well received and excellently informed and had a great conversation, really. Felt like I was to a psychologist, but that may be what I needed, and a neutral third-party that I feel listens to me. […] that is good medicine I think - that someone listens to what I say.” – Interview 6 .

Although some of the topics were considered quite personal, the sick-listed workers mostly experienced a respectful and reassuring dialogue with the caseworker. This personal and accommodating approach was overall positive for the participants, where the caseworkers matched their personality and behavior quite well. For several participants, the early follow-up sessions were considered almost therapeutic:

“You know, I experienced [the sessions] very positively. I met a counselor that displayed a lot of understanding and for me it was almost therapeutic to talk to her. I sat there and though wow, either something has happened to NAV or this person is hand-picked for me.” – Interview 5 .

On the other hand, talking about health-related topics such as psychological well-being while being sick-listed could be emotionally straining. Some considered this therapeutic approach to a session as out of place. When these participants experienced questions from the caseworker as too personal, they saw their caseworker as intrusive and prying into personal issues. Such situations emphasized caseworkers’ position as representative for the social insurance system with its function for control and surveillance.

The results from this study showed that the participants experienced early follow-up sessions by social insurance caseworkers as positive. They described the value of receiving an outside view of their situation and practical information about being on sick leave, while at the same time being met with a supportive and respectful demeanor. These aspects were described as promoting reflection on their situation and their thoughts on RTW. The second session was, however, frequently experienced as superfluous and a repetition of the first session. This can also be seen in the results, where participants to a large degree describe the benefits of simply meeting an understanding NAV caseworker who provide practical information and helps them reflect on their situation, which could be achieved through a single session.

The sick-listed workers who experienced good supportive contact in the current study considered this to be instrumental for their RTW process. Comparatively, some sick-listed workers experienced an absence of support and a distant relationship to their employer. Supportive contact with the employer and workplace has been found to be critical in preventing work disability [ 29 , 30 ] and important for facilitating RTW for sick-listed workers [ 31 ]. The negative impact of lack of workplace support on RTW has also been demonstrated previously [ 29 , 30 , 32 , 33 ]. In the present study, participants to a large degree experienced support from their surrounding network. However, the type of support received has been suggested to play a role, where validation and empathy-based support may promote coping behaviors that are beneficial for RTW, while solicitousness could be detrimental through encouraging illness behavior [ 34 ]. Thus, an outside view of the situation at an early stage of sick leave may be sensible. The present study show that regardless of the support from other stakeholders, getting a second opinion was an exceedingly positive experience which provided an avenue for reflection upon their current situation and their plans going forward. Openness in the dialogue with caseworkers has also been identified as relevant to experience a fair and acceptable sick leave process [ 35 ], and RTW-coordinators arguably are in a position to provide an unbiased perspective on RTW plans, independent of the other stakeholders [ 36 ].

One of the benefits experienced in the present study was a greater understanding of the framework of sick leave. Social insurance literacy relates to the sick-listed individual’s understanding of the social insurance system, how to act on the information obtained, and why decisions surrounding their situation are being made [ 36 , 37 ]. As individuals rarely have thorough knowledge of the social insurance system prior to sick-listing, social insurance literacy is also concerned with how well the system enables them to understand the process [ 38 ]. Previous research has suggested that enhancing the workers’ understanding of the system could improve their feelings of legitimacy and fairness in the process [ 35 ], and the present study provides some insight into how RTW coordinators could be experienced as helpful in this regard. Participants also described the clear agenda, in which the RTW plan was discussed, as useful. Examining barriers and facilitators for RTW and creating and re-examining the RTW plan is considered crucial to facilitate the RTW process [ 36 ]. The RTW-coordinator has also previously been suggested to have an important role in ensuring joint understanding and communication surrounding expectations and the context of long-term sick leave [ 39 ]. Thus, findings suggest that providing information on the system while inviting the sick-listed workers to reflect on their situation was experienced positively and possibly increased their social insurance literacy. However, the results in this study could also partly be explained by the context. It is possible that by voluntarily enrolling caseworkers and sick-listed workers in a research trial, a more individualized atmosphere was created in contrast to a more standardized RTW-follow-up scheme.

Nonetheless, experiences of the participants in the present study were largely positive and participants experienced being met with respect and understanding. Müssener and colleagues [ 40 ] also concluded in their study that how sick-listed individuals are treated affects their self-confidence and their perception of their ability to RTW. They suggest that the structural prerequisites for the RTW professional, such as having a gatekeeper role compared to a supportive role, seems to impact their treatment of sick-listed people [ 40 ]. The potential of the RTW coordinator to establish a good and trustful relationship with emphasis on the sick-listed workers’ motivation and resources in the RTW process has also been found to be important for RTW [ 41 , 42 , 43 ]. The conflicting roles of social insurance officers, being both facilitators and authority of benefits could potentially hinder the development of this relationship [ 41 ]. As identified by Karlsson [ 36 ], interactions between social insurance caseworkers and clients were perceived as either supportive or mistrustful. In the present study, the results suggest that the NAV-caseworkers may have had a stronger focus on the facilitator role, rather than the role of being gatekeepers of benefits.

In a recent study we found that sick-listed workers’ experienced early follow-up sessions with NAV as a positive experience and that it increased their RTW self-efficacy, when the caseworkers used motivational interviewing [ 25 ]. In the current study, the sick-listed workers met with NAV caseworkers who were not using motivational interviewing but rather using their ordinary approach when assisting sick-listed individuals. However, the experiences of the participants were strikingly similar in these two studies. The caseworker and sick-listed worker engaged in cooperatively reflections about when and how to RTW, which the sick-listed workers experienced to be valuable support and feedback for their RTW process. There may be some parallels to research on clinical psychotherapy, where studies have shown that the method of therapy may not be as important as the characteristics of the therapist [ 44 , 45 ]. For instance, having interpersonal skills that enable a therapeutic alliance in which one can effectively promote a course of action and create belief in change is considered vital [ 46 ]. Thus, being met by an emphatic and understanding caseworker may be beneficial, regardless of approach to the sessions. The present study supports the notion that having an early face-to-face meeting with a NAV caseworker can be a positive experience in the RTW-process for long-term sick-listed workers.

Whether positive experiences with the social insurance system translates into RTW-rates is still debatable. On the one hand, a recent systematic review on RTW coordinators’ impact on RTW found that work absence duration and intervention costs were reduced when sick-listed workers had face-to-face contact with a RTW coordinator [ 19 ]. On the other hand, previous research has discussed the lock-in effect of programs through the social insurance service, which may lead to longer periods on sick leave [ 47 ]. Similarly, regular contact with the social insurance office has been shown to have a negative effect on RTW-rates, which may indicate the risk of developing a ‘social insurance career’ [ 48 ]. In a previous study we found that sick-listed individuals also experienced that caseworkers frequently recommended a slower RTW pace than what was originally planned [ 25 ]. Furthermore, even though the experiences of early contact with NAV-caseworkers in the present study was positive, no impact on RTW outcomes could be identified in the trial results [ 49 ].

Strengths and limitation

A strength of the current study was the use of semi-structured interviews. This allowed the participants to elaborate and describe their experience of the early follow-up sessions in relation to their RTW process. In order to explore and uncover different experiences and nuances of the early follow-up sessions, a broad exploratory approach was used with a heterogenous sample. All analytical steps and preliminary findings were discussed with members of the research group to strengthen the interpretations, and final results were validated by all authors. The study also has some limitations. First, caseworkers performing the sessions voluntarily submitted to take part in the RCT and to undertake the follow-up sessions. They received no motivational interviewing training but were recruited from the same offices that those in the motivational interviewing group. This means there could be selection where caseworkers who were more interested in early follow-up were more likely to take part. Furthermore, there could be a spillover effect in the office, where caseworkers receiving motivational interviewing training pass on their knowledge to others in the office. We do however believe the impact of the spillover effect was small as recruitment was from one of the largest NAV-offices in Norway, and our previous study show that extensive training in motivational interviewing was required to achieve beginning proficiency [ 23 ].

Some participants in the study may have failed to recall information and details from the early follow-up sessions, since the interviews were conducted several months (ranging from 1 to 6 months) after the intervention. Although none of the participants expressed any difficulties in the interviews, there is a risk that the sick-listed workers held back information if they feared there would be consequences for their benefits. The current study recruited participants from a RCT with a response rate of approximately 15%. From this sample, the current nested study had a response rate of 65%. This indicates a selection bias, where participants agreeing to participate have different characteristics than those declining. Such bias might reduce variety in the experiences of the early follow-up sessions.

Sick-listed workers considered additional early sessions with social insurance caseworkers as a positive addition to ordinary RTW follow-up. Having these early face-to-face meeting with respectful and accommodating caseworkers that also asked critical questions about participants’ situation, provided sick-listed workers with an outside perspective that enabled them to reflect on their situation. This was experienced as a useful addition to their friends, family and colleagues who were largely supportive. Furthermore, the sessions provided the sick-listed workers with an arena for receiving practical information on the framework of sick-leave follow-up, such as rights, obligations, and possibilities in strategies for RTW. This enabled them to adjust their plan towards RTW. Finally, having individual face-to-face sessions also changed participants’ perceptions of NAV from a anonymous entity to emphatic and understanding individuals, who seemed genuinely interested in assisting them back to work. Thus, from the perspective of the sick-listed individuals, early additional follow-up sessions were experienced as exceedingly positive and would be welcomed in addition to standard follow-up.

Data availability

To protect the anonymity of the participants, the datasets generated and analyzed during the current study are not publicly available. Redacted versions are available from the corresponding author upon reasonable request.

Abbreviations

General practitioner

Norwegian Labor and Welfare Administration

• Return to work

Randomized controlled trial

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Acknowledgements

We thank the caseworkers at NAV and the participants of the study.

Funding granted by The Research Council of Norway (Grant number: 256633). The funding organization had no role in the planning, execution or analyses of the study.

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MIS and VSF co-wrote the article. LA, EAF and MS contributed in the conception of the project. All authors designed the interview study. VSF analyzed and interpreted the data, and MIS, LA, EAF and MS contributed during the analysis process. The final categories were validated by all authors. VSF drafted the manuscript while MIS, LA, EAF and MS revised the manuscript. MIS finalized the article, and all authors revised the final version. The authors read and approved the final manuscript.

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The study was approved by the Regional Committees for Medical and Health Research Ethics in South East Norway (No: 2016/2300), and the trial was prospectively registered at clinicaltrials.gov NCT03212118 (registered July 11, 2017). The sick-listed workers were informed that the intervention was part of a research project and did not affect their rights or obligations as sick listed. Written informed consent was obtained from all participants prior to conducting interviews. The study was performed in accordance with the Declaration of Helsinki and the Guidelines by The Norwegian National Research Ethics Committee for medical and health research.

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Standal, M.I., Foldal, V.S., Aasdahl, L. et al. Getting an outsider’s perspective - sick-listed workers’ experiences with early follow-up sessions in the return to work process: a qualitative interview study. BMC Health Serv Res 24 , 609 (2024). https://doi.org/10.1186/s12913-024-11007-x

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Identification, establishment of connection, and clustering of social risks involved in the agri-food supply chains: a cross-country comparative study

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• Guoqing Zhao   ORCID: orcid.org/0000-0003-4553-2417 1 ,
• Shaofeng Liu 2 ,
• Carmen Lopez 3 ,
• Yi Wang 4 ,
• Haiyan Lu 5 &
• Jinhua Zhang 2  

Supply chain risk management (SCRM) literature is heterogeneous. While much attention has been given to the economic and environmental dimensions, the social dimension has so far received less focus. Thus, this study analyzes the social risks involved in the agri-food supply chains (AFSCs) of Argentina and China by employing an integrated approach. Semi-structured interviews were used to collect data, followed by using a combination of three complementary data analysis methods: thematic analysis to identify social risks, total interpretive structural modeling (TISM) to build interrelationships among the identified social risks, and fuzzy MICMAC (cross-impact matrix multiplication applied to classification analysis) to cluster social risks into four categories. Next, we conducted a comparative analysis between the two countries. Theoretical contributions are mainly threefold. First, we identified various social risks involved in the AFSCs of Argentina and China, including those just touched on by scholars, such as cultural issues, government’s weak monitoring system, the power differential between managers and subordinates, inappropriate disposal of agrichemical containers, and the lack of basic literacy skills. Second, we believe that our study is the first to establish connections among the identified AFSC social risks, which represents the originality of this work. Third, we discover that cultural issues is the key risk that has the highest capability to elicit other social risks involved in the AFSCs. Our work extends scholarship’s knowledge to understand AFSC social risks from the cultural perspective. This study also generates contributions to policymakers, migrant associations, and the government tax departments of Argentina and China.

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Appendix 1 Interview guide

I. Interviewee information .

What is your current designation?

Can you give me a brief introduction to your job within the company’s operations? Probe – What type of crop(s) do you grow/process/deliver?

How many years of your working experience have been in agriculture? Probe – What kind of agricultural activities have you done (e.g., pest management, harvesting and marketing).

How many years of your working experience have you been in the same job role in total? Probe – Have you done other jobs related to agriculture or agri-food supply chains?

II. Company information .

Can you give me an overview of the company’s operations? Probe – How do you understand agricultural business and its role in supply chains?

How many employees are working for the company? Probe – Have you employed any temporary workers?

Can you give a brief overview of your company’s upstream and downstream collaborators in the AFSC?

III. Social risks involved or experienced .

How would you describe the sources of social risks that affect your company? Probe – What affects your company, such as loss of reputation and profit?

How would you describe any social risks related to violating human rights? Probe – How do you understand children working with their parents? How do you understand forced and bonded labor? How do you understand local migrant worker rights violations?

How would you describe any social risks related to labor practices and decent work conditions? Probe – How do you understand limited or no access to personal protective equipment? How do you understand over time work? How do you understand local poor-quality water?

How would you describe any social risks related to society? Probe – How do you understand the unavailability of public facilities? How do you understand exposure to unemployment?

IV. Measures adopted or will be adopted to tackle social risks .

How would you describe any measures or strategies that have been adopted by your company to tackle social risks related to violating human rights?

How would you describe any measures or strategies that have been adopted by your company to improve the working conditions of employees?

How would you describe any measures or strategies that have been adopted by the local government to tackle social risks from the whole society’s perspective?

How would you describe any measures or strategies that have been adopted by the focal company of the AFSC to tackle social risks?

Appendix 2 Detailed information of each interviewee involved in this study

Appendix 3(a) initial and final reachability matrix of afsc social risks of argentina.

• Note : * means transitivity

Appendix 3(b) Initial and final reachability matrix of AFSC social risks of China

Appendix 4(a) partitioning the reachability matrix into different levels – argentina, appendix 4(b) partitioning the reachability matrix into different levels – china, appendix 5(a) binary direct reachability matrix of argentina, appendix 5(b) binary direct reachability matrix of china, appendix 6(a) fuzzy direct reachability matrix of argentina, appendix 6(b) fuzzy direct reachability matrix of china, appendix 7(a) the fuzzy micmac stabilized matrix of argentina, appendix 7(b) the fuzzy micmac stabilized matrix of china, rights and permissions.

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Zhao, G., Liu, S., Lopez, C. et al. Identification, establishment of connection, and clustering of social risks involved in the agri-food supply chains: a cross-country comparative study. Ann Oper Res (2024). https://doi.org/10.1007/s10479-024-06040-2

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Received : 02 September 2022

Accepted : 26 April 2024

Published : 09 May 2024

DOI : https://doi.org/10.1007/s10479-024-06040-2

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