title: Barriers and facilitators for implementation of a return-to-work intervention for sickness absence beneficiaries with mental health problems: Results from three Danish municipalities.
abstract: OBJECTIVE
  Evidence for the effectiveness of return-to-work (RTW) interventions aimed at sickness absence beneficiaries with mental health problems (MHPs) is still relatively sparse and mostly inconclusive. This may in part reflect the varying settings and inconsistent implementations associated with the interventions. The aim of this paper is to identify barriers and facilitators for the implementation of a coordinated and tailored RTW-intervention implemented at three different sites.
  
  
  METHODS
  We used qualitative and quantitative data to assess the implementation according to process evaluation guidelines. Data sources were individual and group interviews, observations, national registers, and documents used in the intervention.
  
  
  RESULTS
  The quality of the implementation varied greatly across the three settings. Barriers included lack of skills to assess MHPs according to the inclusion criteria, different interpretations of sickness absence legislation among stakeholders, competing rehabilitation alternatives, and lack of managerial support for the intervention. An important facilitator was the motivation and availability of resources to solve disagreements through extensive communication.
  
  
  CONCLUSIONS
  The different settings presented various barriers and facilitators, which resulted in different versions of the intervention. A higher degree of user involvement in the design and development phase is likely to improve the implementation quality of future interventions.
authors: National Research Centre for the Working Environment, Denmark Department of Psychology, University of Copenhagen, Denmark martiemdk@yahoo.dk.
authors: Marie H T
authors: MH
authors: Martin
authors: Department of Social Services, Denmark.
authors: Louise
authors: L
authors: Moefelt
authors: COWI, Denmark.
authors: Maj Britt
authors: MB
authors: Dahl Nielsen
authors: National Research Centre for the Working Environment, Denmark Department of Psychology, University of Copenhagen, Denmark Department of Public Health, University of Copenhagen, Denmark.
authors: Reiner
authors: R
authors: Rugulies
mesh_terms: D000328:Adult; D002947:Cities; D003718:Denmark; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008875:Middle Aged; D036301:Qualitative Research; D062707:Return to Work; D018582:Sick Leave
keywords: Return-to-work; anxiety; depression; implementation; intervention; mental health problems; process evaluation; stress; trial