Irene Jensen

Research problem and specific questionsThe profession of publicly financed personal assistant provides opportunities for persons with disabilities (‘assistance users’) to participate fully in society. The profession has specific working conditions that make it essential to study from a health perspective: personal assistants work in various environments, they often work alone in the user’s home, under varying terms of employment depending on whether the assistance organizer is private, public, cooperative or the users themselves. Moreover, the profession has high levels of sickness absence, is female-dominated, low-waged, and requires no formal education. Therefore, research on how health and the work environment interact in this profession is necessary to ensure a sustainable working life. Previous research has highlighted the importance of employers (with responsibility for safety and health at work) in the return to work process.The aim is to examine personal assistants’ and their employers’ perceptions of facilitators and barriers for return to work after sickness absence due to common mental disorders (CMDs).Data and MethodThe project has a qualitative approach. Data will be collected through two semi-structured interviews three months apart with 20–25 personal assistants and 20–25 employers/ managers.Societal relevance and utilisationCMDs are common causes of sickness absence, and women have a higher risk of becoming sick-listed than men. The profession of personal assistants suffers from high sickness absence and various insecure working conditions. Knowledge should be translated into practical measures through collaboration, remain sensitive to the legal rights of assistance users, and be useful in employers’ occupational safety and health management.Plan for project realisationThe main costs consist of salaries for the projects’ researchers. Additional costs include fees for ethical review, transcription services, language review, and collaboration.

There is an urgent need for more knowledge on effective implementation strategies, as two-thirds of implementation efforts fail to achieve the intended change, and half have no effect on outcomes of interest. These implementation failures are partly due to the limited understanding of how implementation strategies work—the mechanisms of change through which implementation strategies affect implementation. This project will fill this research-gap by incorporating mediation analyses into a cluster randomized controlled trial that compares the effectiveness of two implementation strategies for implementing the Guideline for the prevention of mental ill-health at the workplace in schools. Schools are chosen as the setting for implementation given the high prevalence of mental ill-health among teachers. Moreover, they lack a structured approach to the prevention of mental ill-health. The aim of the project is to investigate how implementation strategies affect the defined mechanisms and guideline implementation. The mechanisms of the following implementation strategies will be compared: a discrete strategy that includes an educational meeting (control group) and a multifaceted strategy (intervention group) that combines the educational meeting with workshops, implementation teams and evaluative and iterative strategies (e.g. Plan-Do-Study-Act cycles). Our hypothesis is that schools that receive the multifaceted implementation strategy will show a greater increase in guideline adherence at follow-up than schools that only participate in an educational meeting. Mechanisms that will be tested include hypothesized mediators originating from the individual behavior change theory COM-B. The project will be conducted in primary schools (n=50) in four municipalities in Sweden. Adherence to the guideline will be assessed at baseline and 6, 12- and 24-months follow-up, and mediators at baseline and 3, 6, 9, 12- and 24-months follow-up. Mixed methods will be used.