# Barriers for return to work as an iatrogenic effect of sickness absence: a proposed conceptual framework and questionnaire based on a cross-sectional study

## TL;DR

This study explores barriers to returning to work after sickness absence, proposing a framework and questionnaire to identify these barriers as iatrogenic effects.

## Contribution

The paper introduces a new conceptual framework and questionnaire for evaluating barriers to return to work as iatrogenic effects of sickness absence.

## Key findings

- The questionnaire showed strong internal consistency with a Cronbach’s Alfa of 0.83.
- Patients reported barriers related to health cognitions, aligning with the proposed conceptual framework.
- Results suggest the need for revising the questionnaire for improved accuracy.

## Abstract

Sickness absence and disability incurs negative effects on both individuals and society as a whole. This necessitates more knowledge about the possible factors and mechanisms that perpetuate sickness absence, increasing the risk of permanent exclusion from the labour market. The aim of this study is to evaluate a proposed conceptual framework and questionnaire for barriers for return to work. Here, barriers are understood as iatrogenic effects of sickness absence that create a lock-in effect which impedes return to work and contributes to an exclusion trap.

A questionnaire has been administered as part of a larger survey issued to patients prior to assessment in a Norwegian Sickness Absence Clinic (NSAC). We explored responses from individuals on sickness absence to the questionnaire, correlations between the questionnaire and work -and health-related measurement instruments, inter-item correlations and Cronbach’s alfa.

We observed associations between the barrier items and work -and health-related measurement instruments. The questionnaire demonstrates a strong internal consistency, with a Cronbach’s Alfa of 0.83. Results indicate a need for revision of the questionnaire.

Patients on sickness absence reported several barriers for return to work. The most prevalent barriers, reflecting cognitions about health, agreed with our proposed conceptual framework of barriers for return to work as iatrogenic effects of sickness absence. Exploring patients’ cognitions in the return-to-work process and intervening on them through well-established intervention strategies like graded exposure and belief change, could be of potential importance in reducing detrimental side effects of sickness absence.

The trial was prospective registered at clinicaltrials.gov on August 9th, 2021. Trial identifier NCT 05006976.

The online version contains supplementary material available at 10.1186/s12889-026-26584-1.