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WORKWELL process evaluation: insights from therapists and line managers

Prior, Yeliz; Battista, Simone; Mathew, Alan; Parker, Jennifer; Gates, Sally; Ching, Angela; Hammond, Alison; Radford, Kathryn; Holland, Paula; O’Neill, Terence W; Culley, June; Walker-Bone, Karen

WORKWELL process evaluation: insights from therapists and line managers Thumbnail


Authors

Sally Gates

Angela Ching

Kathryn Radford

Paula Holland

Terence W O’Neill

June Culley

Karen Walker-Bone



Abstract

Objectives Many individuals diagnosed with inflammatory arthritis (IA) are of working age and experience challenges in maintaining employment. The WORKWELL vocational rehabilitation programme, delivered by occupational therapists (OT) in National Health Service (NHS) rheumatology clinics, is designed to support job retention by aligning individuals’ abilities with their work demands. As part of a multi-centre randomised controlled trial, this qualitative process evaluation explored therapists’ and line managers’ perspectives on the training, implementation, and delivery of WORKWELL to inform its future integration and scalability. Methods A qualitative study was conducted using semi-structured interviews with 26 therapists and five line managers across 17 NHS Trusts in England, Wales, and Scotland, both before and after the trial. Reflexive Thematic Analysis (RTA) was applied inductively, followed by a deductive Normalisation Process Theory (NPT) analysis to explore intervention coherence, engagement, implementation, and sustainability. Results Before the trial, work support was inconsistent, with OTs providing informal advice and signposting but lacking structured vocational rehabilitation (VR) assessments. Post-trial, therapists viewed WORKWELL as a valuable, structured intervention, enhancing job retention support. Remote delivery during COVID-19 was well-received, improving accessibility. However, implementation challenges included time constraints, increased workloads, and staffing shortages. Line managers had limited involvement but recognised the programme’s benefits, though concerns about long-term sustainability remained. Conclusions WORKWELL was successfully integrated into NHS practice, with remote delivery enhancing accessibility. Addressing workforce constraints, managerial engagement, and digital integration could improve long-term feasibility and impact, ensuring sustained access to job retention support for people with IA. Trial registration ClinicalTrials.gov NCT03942783; ISRCTN Registry ISRCTN61762297.

Journal Article Type Article
Acceptance Date Jun 17, 2025
Online Publication Date Jun 25, 2025
Deposit Date Jul 10, 2025
Publicly Available Date Jul 10, 2025
Journal Rheumatology Advances in Practice
Print ISSN 2514-1775
Electronic ISSN 2514-1775
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1093/rap/rkaf076

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