qualitative research and social work

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In This Article Expand or collapse the "in this article" section Qualitative Research

Introduction, introductory works.

Definitions and Descriptions
Quasi-Statistical Approaches
Template Analysis
Editing Approaches
Immersion or Crystallization Methods
Participatory Action Research
Qualitative Inquiry
Rigor and Standards

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Qualitative Research by James Drisko LAST REVIEWED: 25 May 2011 LAST MODIFIED: 25 May 2011 DOI: 10.1093/obo/9780195389678-0047

“Qualitative research” is a term that encompasses a wide variety of research types and methods. Its great variety makes it difficult to define and describe succinctly. This bibliography will offer a general introduction but will inevitably be incomplete. Qualitative research in the social sciences has deep roots in sociology and anthropology. For example, fieldwork and ethnography continue to be pivotal methods in these and other disciplines. The professions have also drawn extensively on qualitative research, though emphasis on quantitative research in the academy after World War II and the current ideology of evidence-based approaches among academics and service funders devalue it. Qualitative research is widely found and widely taught in nursing and in education. It is quite evident, but less prominent, in social work, in medicine, in psychology, and in occupational therapy.

In social work, Jane Addams’s portrayals of the circumstances of immigrant populations in Chicago ( Addams 1895 ) are public qualitative research works that are still highly valued. Indeed, Addams is sometimes claimed as a role model by scholars outside the profession as well as within social work. Mary Richmond’s 1917 Social Diagnosis ( Richmond 1955 ) details a method for learning the psychosocial needs of clients and families in context, drawing on qualitative interviews, observations, and documents. These social work contributions emerged as sociology began to define its research methods ( Znaniecki 1934 ). The widely used traditional case study is one well-known form of qualitative research ( Gilgun 1994 ), though case study methods, purposes, and reporting vary, as does its quality. Social work education has long included both formal and informal training in qualitative data collection methods, including interviewing and participant observation, described by Zimbalist 1977 . Further, the traditional method of process recording has provided both a technique and active training in recording interview data. Beyond documentation, process recording also provided an introduction to active reflection on the participant and on the self that is a key element of professional practice as well as of qualitative research. Since 1994 qualitative research has been required content in the Council on Social Work Education’s accreditation standards for all bachelor’s and master’s level programs.

Addams, Jane, Agnes Sinclair Holbrook Florence Kelley, Alzina P. Stevens, Isabel Eaton, Charles Zeublin, Josefa Humpal Zeman, Alessandro Mastro-Valerio, Julia C. Lathrop, and Ellen Gates Starr . 1895. Hull House maps and papers . New York: Crowell.

Addams sought to document and publicize the living conditions of immigrant populations in Chicago. Her goal was to raise public awareness and to catalyze social change. Both Addams’s methods, which draw on fieldwork from sociology, and her goals, which affirm social justice, are widely evident in qualitative research across disciplines in the early 21st century. Seminal, groundbreaking work from a social work pioneer.

Gilgun, Jane F. 1994. A case for case studies in social work research. Social Work 39:371–380.

Gilgun argues for the wide applicability of the case study method to social work research and to social work practice. The article offers an overview of the case study method and takes stock of the method’s strengths and limitations. A very widely known, classic article.

Richmond, Mary Ellen. 1955. Social diagnosis . New York: Russell Sage Foundation.

First published in 1917. The originator of the psychosocial perspective, Richmond details a qualitative method of diagnosis that balances attention to macro-level social issues with micro-level family and individual concerns. Several case studies portray people-in-environments in great detail and with broad perspective. An early example of social work case studies based on planned interviews and observations—key tools in qualitative research as well.

Zimbalist, Sidney. 1977. Historic themes and landmarks in social welfare research . New York: Harper & Row.

A unique book on the history of social work research. Chronological in plan, the book shows the development of social work research models in context. Extensive use of qualitative methods is documented, and the forces that have promoted quantitative research as a dichotomous alternative to qualitative research are noted. Lacks contemporary perspective, however, given its publication date.

Znaniecki, Florian. 1934. The method of sociology . New York: Farrar & Rinehart.

In this early, classic work in sociology, Znaniecki details the method of analytic induction. Analytic indication seeks deductively to frame new concepts and preliminary theory while maintaining clear connections to its evidence base. This method is clearly the foundation of grounded theory, which followed it in the 1960s.

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Graduate research methods in social work

(2 reviews)

Matt DeCarlo, La Salle University

Cory Cummings, Nazareth University

Kate Agnelli, Virginia Commonwealth University

ISBN 13: 9781949373219

Publisher: Open Social Work Education

Language: English

Formats Available

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Learn more about reviews.

Reviewed by Laura Montero, Full-time Lecturer and Course Lead, Metropolitan State University of Denver on 12/23/23

Comprehensiveness rating: 4 see less

Graduate Research Methods in Social Work by DeCarlo, et al., is a comprehensive and well-structured guide that serves as an invaluable resource for graduate students delving into the intricate world of social work research. The book is divided into five distinct parts, each carefully curated to provide a step-by-step approach to mastering research methods in the field. Topics covered include an intro to basic research concepts, conceptualization, quantitative & qualitative approaches, as well as research in practice. At 800+ pages, however, the text could be received by students as a bit overwhelming.

Content Accuracy rating: 5

Content appears consistent and reliable when compared to similar textbooks in this topic.

Relevance/Longevity rating: 5

The book's well-structured content begins with fundamental concepts, such as the scientific method and evidence-based practice, guiding readers through the initiation of research projects with attention to ethical considerations. It seamlessly transitions to detailed explorations of both quantitative and qualitative methods, covering topics like sampling, measurement, survey design, and various qualitative data collection approaches. Throughout, the authors emphasize ethical responsibilities, cultural respectfulness, and critical thinking. These are crucial concepts we cover in social work and I was pleased to see these being integrated throughout.

Clarity rating: 5

The level of the language used is appropriate for graduate-level study.

Consistency rating: 5

Book appears to be consistent in the tone and terminology used.

Modularity rating: 4

The images and videos included, help to break up large text blocks.

Organization/Structure/Flow rating: 5

Topics covered are well-organized and comprehensive. I appreciate the thorough preamble the authors include to situate the role of the social worker within a research context.

Interface rating: 4

When downloaded as a pdf, the book does not begin until page 30+ so it may be a bit difficult to scroll so long for students in order to access the content for which they are searching. Also, making the Table of Contents clickable, would help in navigating this very long textbook.

Grammatical Errors rating: 5

I did not find any grammatical errors or typos in the pages reviewed.

Cultural Relevance rating: 5

I appreciate the efforts made to integrate diverse perspectives, voices, and images into the text. The discussion around ethics and cultural considerations in research was nuanced and comprehensive as well.

Overall, the content of the book aligns with established principles of social work research, providing accurate and up-to-date information in a format that is accessible to graduate students and educators in the field.

Reviewed by Elisa Maroney, Professor, Western Oregon University on 1/2/22

With well over 800 pages, this text is beyond comprehensive! read more

Comprehensiveness rating: 5 see less

With well over 800 pages, this text is beyond comprehensive!

I perused the entire text, but my focus was on "Part 4: Using qualitative methods." This section seems accurate.

As mentioned above, my primary focus was on the qualitative methods section. This section is relevant to the students I teach in interpreting studies (not a social sciences discipline).

This book is well-written and clear.

Navigating this text is easy, because the formatting is consistent

Modularity rating: 5

My favorite part of this text is that I can be easily customized, so that I can use the sections on qualitative methods.

The text is well-organized and easy to find and link to related sections in the book.

Interface rating: 5

There are no distracting or confusing features. The book is long; being able to customize makes it easier to navigate.

I did not notice grammatical errors.

The authors offer resources for Afrocentricity for social work practice (among others, including those related to Feminist and Queer methodologies). These are relevant to the field of interpreting studies.

I look forward to adopting this text in my qualitative methods course for graduate students in interpreting studies.

1. Science and social work
2. Starting your research project
3. Searching the literature
4. Critical information literacy
5. Writing your literature review
6. Research ethics
7. Theory and paradigm
8. Reasoning and causality
9. Writing your research question
10. Quantitative sampling
11. Quantitative measurement
12. Survey design
13. Experimental design
14. Univariate analysis
15. Bivariate analysis
16. Reporting quantitative results
17. Qualitative data and sampling
18. Qualitative data collection
19. A survey of approaches to qualitative data analysis
20. Quality in qualitative studies: Rigor in research design
21. Qualitative research dissemination
22. A survey of qualitative designs
23. Program evaluation
24. Sharing and consuming research

Ancillary Material

About the book.

We designed our book to help graduate social work students through every step of the research process, from conceptualization to dissemination. Our textbook centers cultural humility, information literacy, pragmatism, and an equal emphasis on quantitative and qualitative methods. It includes extensive content on literature reviews, cultural bias and respectfulness, and qualitative methods, in contrast to traditionally used commercial textbooks in social work research.

Our author team spans across academic, public, and nonprofit social work research. We love research, and we endeavored through our book to make research more engaging, less painful, and easier to understand. Our textbook exercises direct students to apply content as they are reading the book to an original research project. By breaking it down step-by-step, writing in approachable language, as well as using stories from our life, practice, and research experience, our textbook helps professors overcome students’ research methods anxiety and antipathy.

If you decide to adopt our resource, we ask that you complete this short Adopter’s Survey that helps us keep track of our community impact. You can also contact [email protected] for a student workbook, homework assignments, slideshows, a draft bank of quiz questions, and a course calendar.

About the Contributors

Matt DeCarlo , PhD, MSW is an assistant professor in the Department of Social Work at La Salle University. He is the co-founder of Open Social Work (formerly Open Social Work Education), a collaborative project focusing on open education, open science, and open access in social work and higher education. His first open textbook, Scientific Inquiry in Social Work, was the first developed for social work education, and is now in use in over 60 campuses, mostly in the United States. He is a former OER Research Fellow with the OpenEd Group. Prior to his work in OER, Dr. DeCarlo received his PhD from Virginia Commonwealth University and has published on disability policy.

Cory Cummings , Ph.D., LCSW is an assistant professor in the Department of Social Work at Nazareth University. He has practice experience in community mental health, including clinical practice and administration. In addition, Dr. Cummings has volunteered at safety net mental health services agencies and provided support services for individuals and families affected by HIV. In his current position, Dr. Cummings teaches in the BSW program and MSW programs; specifically in the Clinical Practice with Children and Families concentration. Courses that he teaches include research, social work practice, and clinical field seminar. His scholarship focuses on promoting health equity for individuals experiencing symptoms of severe mental illness and improving opportunities to increase quality of life. Dr. Cummings received his PhD from Virginia Commonwealth University.

Kate Agnelli , MSW, is an adjunct professor at VCU’s School of Social Work, teaching masters-level classes on research methods, public policy, and social justice. She also works as a senior legislative analyst with the Joint Legislative Audit and Review Commission (JLARC), a policy research organization reporting to the Virginia General Assembly. Before working for JLARC, Ms. Agnelli worked for several years in government and nonprofit research and program evaluation. In addition, she has several publications in peer-reviewed journals, has presented at national social work conferences, and has served as a reviewer for Social Work Education. She received her MSW from Virginia Commonwealth University.

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Social Work Research Methods That Drive the Practice

A social worker surveys a community member.

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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SWK 327: Social Work Research Methods: Qualitative

Quantitative
Finding Empirical Articles
Qualitative
APA Resources
Literature Review

Tyoes of Qualitative Research

Examples of Common Techniques:

Interviews , which may be structured, semi-structured or unstructured;
Focus groups , which involve multiple participants discussing an issue;
Secondary data , including diaries, written accounts of past events, and company reports; and
Observational - (in a controlled setting), which may be on site, or under ‘laboratory conditions’, for example, where participants are asked to role-play a situation to show what they might do; or , for example (in a public space), which may include places like a mall food court, a playground, a bus stop or other locations where there is no expectation of privacy.

Article location Strategies for Qualitative research

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homeless AND "pet ownership" AND interview
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Evaluating Qualitative Research for Social Work Practitioners The purpose of this article is to provide students and practitioners some orientation regarding qualitative research methods and to highlight some strategies to evaluate the trustworthiness and quality of qualitative research.

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Open access
Published: 26 June 2020

“I need to take care of myself”: a qualitative study on coping strategies, support and health promotion for social workers serving refugees and homeless individuals

Janika Mette 1 ,
Tanja Wirth 2 ,
Albert Nienhaus 2 , 3 ,
Volker Harth 1 &
Stefanie Mache 1

Journal of Occupational Medicine and Toxicology volume 15 , Article number: 19 ( 2020 ) Cite this article

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Social workers provide support for various groups of clients, such as refugees and homeless people. Refugees and homeless individuals represent particularly vulnerable groups in precarious living conditions. Therefore, social workers serving these clients are likely to be confronted with extensive job demands. The aim of this study was to investigate the coping strategies of social workers serving refugees and homeless individuals and to explore their support sources and health promotion offers at work as well as their respective needs.

26 semi-structured qualitative interviews were carried out with social workers in Berlin and Hamburg and analysed according to Mayring’s qualitative content analysis.

The respondents reported various coping strategies to deal with their job demands which involved both problem-oriented (e.g. time management, setting boundaries, seeking support in conflict situations) and emotion-focused approaches (e.g. self-care, distance from work, leisure activities). In addition, they emphasised various sources of workplace (social) support, e.g. provided by team members, supervisors, and other institutions. However, unmet needs for support were also formulated by the workers, e.g. in terms of individual supervision and regular exchange. Furthermore, several employees did not know about any health promotion offers at their workplace and expressed a desire for structural and behavioural health promotion measures.

Conclusions

In view of the diverse needs of the workers, the results can provide a basis to design needs-based health promotion interventions for staff in social work.

Social work in the refugee and homeless aid

In recent years, a persistent upward trend in the number of refugees and homeless individuals has been observed worldwide [ 1 , 2 ]. The global refugee population is constantly increasing, reaching 25.9 million by the end of 2018 [ 1 ]. In the context of the rapidly increasing migration in Europe in 2015 and 2016, a total of 745,545 people submitted asylum applications in Germany in 2016 [ 3 ]. Since then, the number of asylum applications in Germany has declined again (2019: 165,938), which was partly due to the refugee agreement between the European Union and Turkey [ 3 ].

Homelessness has also increased substantially in most countries [ 2 ]. In 2017, there were around 650,000 homeless individuals in Germany, from which the number of homeless recognised refugees was estimated at about 375,000. In fact, there is a notable overlap between the groups of refugees and homeless people; from 2007 to 2017, an increase in the number of non-German EU citizens and non-EU citizens in homeless assistance was observed [ 2 ]. The main reasons cited for the rising number of homeless people in Germany are the insufficient supply of affordable housing, the shrinking social housing stock and the consolidation of poverty [ 2 ].

Refugees and homeless individuals represent particularly vulnerable groups. They find themselves in precarious life circumstances, are often marginalised and frequently suffer from severe traumatic experiences [ 4 , 5 , 6 ]. Prejudices were revealed in recent surveys. For example, in 2017, 80% of German survey respondents feared a burden on the welfare state and 72% feared an increase in social conflicts due to refugee immigration [ 7 ]. Regarding homelessness, in a representative long-term study of the German population, homeless people were perceived as unpleasant (38%) and work-shy (30%) [ 8 ]. Both groups share certain similarities in terms of their precariousness (e.g., their material situation, income, social integration) and regarding their health impairment and strain (e.g. high rates of traumatisation, comorbidities between mental health disorders and substance misuse) [ 4 , 9 ]. In terms of traumatic experiences, the prevalence of traumatisation among refugee clients was found to be around 40–60%, corresponding to a significantly increased risk in these clients [ 4 ]. Overall, both refugees and homeless individuals represent important clients for today’s and future social work [ 1 , 2 ].

Previous research has examined the working conditions and health of various subgroups of social workers, e.g. mental health workers [ 10 ] or child welfare workers [ 11 , 12 ]. However, less attention has been paid to the situation of social workers in refugee and homeless aid. Social workers who provide counselling and care services for refugees and homeless individuals are likely to face similar demands in their daily work [ 13 ], which makes it plausible to conduct research studies that address workers for both client groups simultaneously. For example, particular stress factors for social workers serving refugees and homeless persons consist of cultural and language problems, negative attitudes from public towards their work and their clients as well as high caseloads due to the increasing number of clients [ 13 ]. Moreover, a relatively high prevalence of secondary or post-traumatic stress has been revealed in social workers serving refugees (52% [ 14 ]) and homeless clients (36% [ 15 ]).

In a recent scoping review of 25 studies, evidence on the working conditions, health and coping strategies of social workers serving refugees and homeless individuals was systematically mapped for the first time [ 9 ]. The review revealed common job demands for this staff, including high workloads, the bureaucratic system, clients’ suffering, difficulties in maintaining boundaries with clients, as well as limited success concerning the clients’ progress. Job resources of value to workers were also identified, e.g. a high personal meaning of work and social support from colleagues. Overall, there was a high prevalence of mental health problems (e.g. burnout) among social workers in these areas. At the same time, they were found to show high levels of job satisfaction. The review also demonstrated methodological issues in relation to available studies and claimed for more research to examine the effectiveness of coping strategies and workplace health promotion offers for staff in social work with refugees and homeless clients [ 9 ].

Similar results regarding these topics were obtained in our interview study in which social workers in refugee and homeless aid described high emotional demands, high word loads, a lack of personnel, and overtime work as critical job demands [ 13 ]. In contrast, the joy of working with their clients and appreciation from clients, colleagues and superiors were underlined as job resources. Strain reactions in relation to their work involved perceptions of fatigue and stress (as short-term reactions) as well as sleeping problems, depression and burnout symptoms (as long-term consequences). Moreover, some respondents stated that they felt ill more frequently and reported high levels of sickness absences within their institutions [ 13 ].

Given the recent findings on the job demands and strains experienced by social workers in the refugee and homeless aid as well as the limited evidence, it is important to address the question of how these workers deal with their job demands. Precisely, what coping strategies do they use and what sources of support and health promotion offers at work help them to maintain their health and well-being?

Coping strategies of social workers

In previous studies, social workers in refugee and homeless aid were found to use various coping strategies to deal with their job demands [ 5 , 6 , 16 , 17 , 18 ]. They consisted of accepting the boundaries of one’s sphere of influence [ 18 ] and maintaining professional boundaries with clients [ 5 , 16 , 17 ] and between work and private life [ 5 , 16 , 17 ]. Further coping strategies were to engage in hobbies (e.g. physical activity, reading, listening to music) and to have an active social life and exchange with friends, family members, and colleagues [ 5 , 6 , 16 , 17 ]. Moreover, coping behaviours employed by staff in the homeless sector included the acknowledgement of small successes [ 5 ] and the acceptance of clients’ undesirable behaviour without taking it personally [ 19 ]. In addition, in a study with social workers serving unaccompanied asylum-seeking refugee children, the workers used both emotion-focused (e.g. positive reappraisal, distancing) and problem-focused strategies (planful problem solving) [ 20 ].

In general, evidence from coping research suggests that coping may have an impact on the link between employees’ working conditions and health [ 21 ]. This buffering effect has also been proven in the area of social work [ 12 , 22 ]. For example, using active control-oriented coping behaviours which implied personal engagement (e.g. problem solving, cognitive restructuring, expressing emotions) buffered the impact of work stress on the emotional exhaustion and job satisfaction of social workers [ 12 , 23 ]. Similarly, in a study with child protection workers, the use of active and engaged coping strategies (rather than avoidant coping strategies) led to a decline in depersonalisation levels and increased employees’ sense of personal accomplishment [ 22 ].

Sources of support for social workers

Research suggests that further sources of support at work may help social workers to deal with their job demands [ 16 , 17 , 24 , 25 ]. In general, team support has been described as a relevant job resource for social workers [ 16 , 17 ]. Furthermore, several forms of supervision and training have been highlighted in their importance [ 16 , 24 ]. In a study with case managers serving homeless clients, managers were offered an occupational therapy consultant who provided client assessments and treatment recommendations [ 25 ]. The results showed that case managers who used the consultations more actively showed higher levels of job satisfaction and self-efficacy.

However, disparity was found in previous studies with regard to whether staff felt adequately supported or wished for more support at work [ 16 ]. Indeed, social workers in refugee and homeless aid expressed the need for external counselling, supervision and training (e.g. on self-protection or to better understand new policies) [ 5 , 16 , 17 , 24 , 26 ]. In a study with German refugee aid workers, the workers particularly wished for training to better recognise the mental health problems of their clients and learn about suitable intervention strategies [ 27 ]. In addition, frontline homeless workers expressed a desire for more support (e.g. in the form of manuals, additional personnel and supervision), team development activities and greater recognition of their needs [ 15 ].

Workplace health promotion for social workers

Studies in the area of social work, in particular refugee and homeless aid, have not yet focused on the topic of workplace health promotion. Therefore, it is still unclear to what extent social workers may benefit from health promotion offers. In general, meta-analyses indicate that workplace health promotion can contribute to maintaining employees’ health and well-being, e.g. with regard to their physical activity [ 28 , 29 ], dietary habits [ 30 , 31 ], and mental well-being [ 32 ]. Health promotion offers were also found to be associated with reduced job stress [ 28 ] and sickness absence [ 28 , 32 , 33 ] as well as increased work ability [ 32 ]. Moreover, they were related to economic benefits for companies in the form of a high return on investment [ 34 , 35 ]. In view of the possible positive effects of workplace health promotion, it seems worthwhile to explore the availability of such offers for the target group more closely.

Theoretical framework

To investigate the coping strategies of social workers, the concept of coping by Lazarus and Folkman was used as a theoretical framework [ 36 , 37 ]. According to this model, coping is defined as cognitive and behavioural efforts made to master, tolerate or reduce external and internal demands, as well as conflicts among them [ 36 , 37 ]. Coping is seen as a buffer between stressors and health outcomes [ 38 , 39 ]. Before coping behaviour is initiated, a cognitive-transactional process takes place which encompasses a primary cognitive appraisal (evaluation of the situation as potentially stressful) and a secondary cognitive appraisal (assessment of available coping resources) [ 36 , 37 ]. Coping strategies either aim at managing the stress-inducing problem (problem-focused) or at regulating emotions or distress caused by the problem (emotion-focused).

To examine the sources of support for the workers, we primarily referred to the concept of workplace social support [ 40 ]. Workplace social support emanates from multiple sources, such as supervisors, colleagues and the institution. A meta-analysis concluded that workplace social support includes both an individual’s belief that one is valued, appreciated and cared for, as well as the perception that one has access to helping relationships of varying quality and strength [ 40 ].

To assess the availability of health promotion offers and social workers’ respective needs, the Luxembourg Declaration on Workplace Health Promotion provided a useful framework [ 41 ]. The declaration defines workplace health promotion as “the combined efforts of employees, employers and society to improve the health and well-being of people at work”. Health promotion offers can include behavioural and structural interventions; the former aim at changing behavioural patterns of individuals or groups, while the latter refer to environmental and political interventions to influence health-related ecological, social, cultural and technical-material environments [ 42 ].

Study aims and research questions

The aim of the study was to investigate the coping strategies of social workers in homeless and refugee aid to deal with their job demands. In addition, we aimed to explore the sources of support and health promotion offers for these workers, as well as their respective needs. To address our study objectives, we proposed the following research questions:

What coping strategies do social workers in refugee and homeless aid use to deal with their job demands?

What sources of support are available to social workers in refugee and homeless aid at their workplace?

What health promotion offers are available to social workers in refugee and homeless aid, and what are their respective needs that are currently not addressed?

Materials and methods

Study design.

We conducted 26 semi-structured qualitative interviews with staff in social work in Berlin and Hamburg. Interviews were carried out from October to December 2017. The qualitative approach was chosen as it allowed us to gain first explorative insights into little researched topics. Since little was known about the topics for the specific target group, a qualitative investigation was most suitable to get a comprehensive and detailed understanding. A central advantage of the qualitative method is that it allows to describe complex social phenomena from the perspective of the people affected. Semi-structured interviews were especially suitable in order to approach the target group and study the topics within their natural environment [ 43 ]. The results of the qualitative study were subsequently used as a basis to design a quantitative online survey.

Recruitment of participants

Participants were recruited from institutions in the refugee and homeless aid sector. Purposeful sampling was applied to the selection of institutions by contacting walk-in and residential facilities from various supporting organisations. Institutions were informed about the study by telephone and sent invitation emails and leaflets which were distributed within the organisations. In total, 19 institutions were contacted from which 10 agreed to participate. Employees who were interested in participation could contact the researchers confidentially and directly to make interview appointments (convenience sample). Eligibility criteria for study participation were as follows: participants had to have direct contact with refugees and/or homeless individuals at work and at least 6 months of work experience in social work. Moreover, they had to be of full age and fluent in the German language. Volunteers and employees working in administrative services without direct contact to clients were excluded from the study.

Data collection

A semi-structured interview guideline was developed based on the empirical evidence and theoretical background. The questions of the interview guideline regarding the coping strategies, sources of support and health promotion are provided in Additional file 1 . The guideline consisted of further questions, e.g. regarding social workers’ working conditions and strains, which are presented elsewhere [ 13 ]. A pretest interview was carried out with a former social worker from refugee aid. The guideline was slightly revised based on the workers’ recommendations. The interviews were conducted by two female researchers, a health scientist and a psychologist who were experienced with qualitative research and worked as researchers in occupational health psychology during the study period. Prior to data collection, participants were informed about the study aims and data confidentiality and signed a declaration of informed consent. All interviews were carried out face-to-face and took place in the workers’ institutions during their work time. The interviews were conducted in German and recorded with an audio device. They lasted from 27 to 86 min (51 min on average). The participants were able to terminate the interviews at any time. Interviews were conducted until no new topics were identified, i.e. data saturation was reached. Field notes were made immediately after each interview. No repeat interviews were carried out.

Data analysis

The audio recordings were transcribed verbatim and subsequently anonymised. The data analysis was carried out in a deductive-inductive process according to Mayring’s qualitative content analysis [ 44 ]. Important features of this analysis include the systematic and rule-based approach and the development of a profound category system [ 44 ]. The well-validated, rule guided process applied in Mayring’s content analysis strengthens the reliability of the qualitative results. Qualitative content analysis was chosen, since this method focuses on the content (rather than on the latent meaning) of what is said [ 45 ]. Thus, we adopted a realistic position in the theory of science by focusing on the semantic content of the data [ 45 ]. The main categories were retrieved deductively on the basis of the interview guideline. Moreover, sub-categories were developed inductively in an iterative process. First, one interview was test-coded by both interviewers and compared in terms of consensus. Disagreements were thoroughly discussed until consensus was reached and the coding system was slightly revised. The other interviews were then each coded by one interviewer. Unclear coding was regularly discussed during team meetings. The software MAXQDA Analytics Pro (version 11) was used for the analysis [ 46 ]. The final coding system was summarised in a separate document in which the material was further compacted (paraphrased, generalised and reduced) in accordance with Mayring’s specifications [ 44 ]. During the analysis, the researchers’ personal involvement, preconceptions and influence on the results and interpretations were thoroughly reflected upon. In order to minimize such personal influences, special emphasis was placed on discussing results in the team and weighing up alternative paths of interpretation together to increase validity of the findings. Results were not made available to the participants before completion of the data analysis. Direct quotes from the interviewees were translated into English by a native speaker. The COREQ-Checklist was used to describe the study [ 47 ].

Participant characteristics

In total, 17 interviewees were female and 9 were male (Table 1 ). They were aged between 26 and 64 years with a mean age of 42 years. The majority had a degree in social work ( n = 16). 14 interviewees worked in homeless aid and 12 in refugee aid. Most of the participants worked full-time ( n = 20) and had three or less years of experience in social work ( n = 15).

Coping strategies

The coping strategies presented in the following were named by the participants as strategies they actually applied and perceived as helpful. The strategies were classified into problem-oriented and emotion-oriented strategies.

Problem-oriented strategies

Problem-oriented strategies referred to employees’ work tasks and content, to the work organisation, social relations and personal strategies (Table 2 ).

Work tasks and content

Some employees reported that they had actively reduced their work tasks and only accepted tasks they were responsible for and able to finish on time. Moreover, acquiring knowledge in dealing with stress was described as a coping strategy and associated with an increased sense of security and the development of a professional identity. Knowledge was, for example, acquired through training and education, reading books and having discussions with experts in the field. Moreover, independent problem-solving and solution-oriented thinking were reported as a further coping strategy at work:

“There is a lot of collaborative thinking involved, and a lot of ‘Yes, okay, how can we solve this now? It’s hard, of course, but we’ll try to find a solution for this now too.’ And, yes, there is a lot of willingness too.” [#21, female, homeless aid].

Work organisation

With respect to work organisation, having good time management was an important strategy. This included scheduling enough breaks between appointments and avoiding appointments at the beginning of a working day to be able to prepare for the day. Furthermore, compliance with regular working hours, breaks and counselling times and the avoidance of overtime work were highlighted in order to recover briefly during breaks and between consultations:

“Yes, so at the beginning I did a lot more overtime. And, well, now I’m trying to curb that a bit. (…) Including when it comes to consulting time. “[#9, female, homeless aid].

Two interviewees mentioned that they had deliberately reduced their work time in order to decrease their workloads, which was perceived as a relief. In situations of high workload and time pressure, another strategy named by the interviewees was to prioritise tasks that needed to be done:

“Setting priorities. You learn that with time. What can I move, what can I let go? (…) But that simply comes with experience, which comes with time.” [#23, male, homeless aid].

Many interviewees described that setting clear boundaries between work and private life was an essential strategy to be able to switch off from work. These people explained, for example, that they did not share their private telephone numbers with clients, did not meet clients in their spare time and did not discuss work-related problems at home with their family and friends:

“Sometimes we even make it clear, and say that today we aren’t going to talk about work, or about clients, or about anything remotely to do with social work. Simply so that you can switch off for once.” [#22, female, homeless aid].

Two interviewees also described their efforts to create change at higher levels of the system, e.g. through discourse with responsible staff, committee work or work situation analyses at their workplaces in order to identify critical job demands.

Social relations

Several workers reported setting limits towards clients at work as a fundamental coping strategy. This involved showing clients the limits for aid and support, pointing out clients’ personal responsibilities and encouraging them to reflect on their (sometimes unrealistic) expectations:

“Sometimes there are these expectations: ‘You’re my support worker, you have to solve this for me or do that for me.’ And we have to tell people again and again, I can help you with this and that issue, I’m here to help you with this, but this and that you have to do yourself.” [#24, female, refugee aid].

Employees stated that it was particularly important to set clear boundaries in cases where clients showed demanding and aggressive behaviour or disrespectful conduct towards women:

“And I set really clear boundaries. If they come in acting in an aggressive manner and insult me, then I say: ‘You have to leave now and when you’ve calmed down, then you can come back and we can talk to each other calmly.” And then they might come back a couple of days later and have calmed down.” [#25, male, refugee aid].

A general coping strategy in conflict situations consisted of acting self-confidently, calmly and in a self-determined manner, while showing understanding and empathy for the clients’ needs at the same time. Moreover, actively searching for support in challenging situations was another strategy stated by many interviewees; for example, asking colleagues for help, requesting additional supervision or calling the police as a last resort in cases where clients acted in an extremely violent or aggressive manner:

“And when it’s totally unacceptable and residents won’t calm down at all, then I just call the police.” [#22, female, homeless aid].

In addition, overcoming language barriers with clients by communicating through gestures and mimicry was reported as a strategy by one worker. Another respondent described that it was important to discuss conflicts with colleagues and superiors (e.g. bullying, gossip) directly and openly with the involved team members.

Personal strategies

With respect to coping strategies at a personal level, one worker mentioned receiving medical treatment for insomnia and sleep disorders. Furthermore, three interviewees stated that they had started psychotherapy to be able to talk about their job strain and learn about mechanisms to better deal with their demands at work:

“A year ago I started psychotherapy because I was just going straight to sleep when I got home from work. And I simply wasn’t doing anything else (…). It was just work and sleep, work and sleep. So that’s why I started therapy and have learned how to deal with this strain.” [#4, female, refugee aid].

In this regard, psychotherapy sessions were described as a substitute for a lack of collegial counselling and individual supervision that was not provided by the employer:

“In the end I sorted out psychotherapy for myself (…). I just simply got to the point where I said, ‘Okay, I have to look after myself, because what I need isn’t happening here.’” [#6, female, refugee aid].

Emotion-oriented strategies

The emotion-oriented coping strategies named by the interviewees are depicted in Table 3 .

Seeking emotional support and exchange with partners, parents and friends represented an important emotion-oriented coping strategy for many participants, especially when there were acute problems at work. In addition, a lot of the interviewees highlighted the relevance of regular exchange with their colleagues, and sometimes also with executives:

“There you can also (…) talk about things that are bothering you at the moment or just vent. That really helps a lot.” [#2, female, homeless aid].

Engagement in leisure activities

Further emotion-oriented coping strategies were related to the engagement in leisure activities to seek distraction, detachment and a balance with work. Many respondents emphasised that they preferred active activities in their spare time, such as sports or physical activity (e.g. sports courses, cycling, swimming, dancing and horse riding). Spending time and pursuing activities with friends and family was often deemed helpful. Other workers reported that they preferred calm activities as a contrast to their busy working lives, e. g. yoga, qi gong, or going to the sauna:

“Well, I can already see that I really need to relax and recover a lot in my private life, so there you really have to find an absolute counterbalance, otherwise it gets really difficult.” [#11, female, refugee aid].

Spending time in nature and outdoors, for example going for walks with the dog or gardening, was described as a compensation for stressful and mainly sedentary work. According to several workers, it represented a good way to switch off from work:

“I surround myself in nature a lot. I go out with my dog and even sometimes make my journey to or from work longer and use the time to go for a walk or bike ride (…). And by doing that I definitely unwind.” [#3, female, homeless aid].

Creative hobbies were also mentioned by some respondents, e.g. making music, singing, writing, sewing or photography. Others indicated reading or using media, such as TV or the computer, to detach from work.

Acceptance and focus

Another coping strategy mentioned by many respondents consisted of withstanding negative feelings at work (e.g. caused by criticism regarding one’s way of working). As described by the interviewees, such feelings could be reduced by cognitively distancing oneself from criticism and confidently following one’s own work tasks. Moreover, accepting situations that could not be changed was described as important, for example, with regard to the fates of clients, when clients maintained their unrealistic expectations or did not accept help:

“Well, just by simply saying: ‘I accept the situation as it is.’ Being able to do that is also pretty difficult, as you actually have your own ideas of how things might go for people, but it often just doesn’t work out.” [#9, female, homeless aid].

In addition, one interviewee underlined that it was helpful to concentrate on the positive sides of work and to remind oneself and one’s clients of previous positive achievements:

“(…) that again and again you try to concentrate on the positive things and remind yourself: What went well and what have you already achieved?” [#2, female, homeless aid].

Self-care and mindfulness

Further coping strategies were related to the workers’ self-care. Some interviewees stressed the importance of reporting sick in the event of illness and of taking short breaks at work despite potentially negative comments from colleagues or postponed work. Various workers talked about not being put under stress, being mindful, knowing one’s limits and not working beyond them. Increasing awareness of one’s own needs was described as essential, as well as taking concrete actions for recovery at work, e.g. using relaxation techniques, having active breaks or following healthy eating:

“You have to watch out for that, and when you realise, you have to say: ‘Okay, good, I have to look after myself a bit too.’ So simply that you keep an eye on yourself.” [#7, female, homeless aid].

Distance to work

Creating distance from work, especially from clients’ problems and concerns, was described as a useful coping strategy to better deal with challenges and perceived failures in the work context. This meant taking a step back from clients’ problems and “getting a big tank”:

“I try maybe to not let everything get to me. So (…) that they are their problems, not my problems, basically.” [#1, female, homeless aid].

It also meant not taking failures, aggression or appointment cancellations by clients personally. Helpful mechanisms were to consciously reflect and understand that failures had nothing to do with one’s professional skills, and to recall the clients’ responsibilities:

“It’s really a question of attitude (…), that people are always independent and act independently. And, yes, that I offer support and provide guidance, but that I can’t do things for them (…).” [#21, female, homeless aid].

Sources of support

There were various sources of support mentioned by the interviewees, many of them relating to workplace social support, i.e. interpersonal relationships in the work context (Table 4 ).

Support from colleagues and supervisors

Social workers repeatedly stated that support was provided by their colleagues in the form of collegial advice in difficult situations, which was especially helpful for finding quick solutions. Good team spirit and sense of community were also underlined by most of the workers. It was stated that colleagues cared for each other and that an open question culture was promoted:

“Well, advice from colleagues, that goes really fast. We simply go from door to door or we arrange to meet, that goes pretty well and works out pretty well.” [#8, male, homeless aid].

Moreover, supervisors’ support was mentioned. For example, it was specified that they were approachable for work-related questions and particularly supportive in difficult situations at work:

“And that we also have a boss who is receptive to us and takes us seriously. That’s also worth a lot and I have had completely different experiences with that.” [#2, female, homeless aid].

Team meetings

Team meetings were also pointed out as an important source of support by several workers. In many cases, meetings in small teams were held once a week. Meetings in larger teams, e.g. cross-departmental or cross-location meetings, took place every 2 weeks, once a month or every 3 months. Team meetings were predominantly regarded as helpful for regular exchange and, in some cases, for collegial case consulting. However, some participants perceived the meetings as too superficial or too short to provide enough time for detailed discussion:

“Case assessments are sometimes too short because in team meetings we have to talk about organisational issues and things like that, and in the end case discussions are neglected a bit.” [#20, female, homeless aid].

Team meetings were sporadically used to develop concrete measures for improving the work conditions. Examples for such measures were the provision of number assignments for clients for open consultation hours, the use of stop signs indicating that there was no consultation hour, and the provision of mobile phones for communication with clients. Three workers also explained that conceptual and strategic planning took place on so-called “concept days” in the institutions:

“Well, we do concept days here where we get together and talk and think about next steps. And actually I find that pretty ideal here.” [#10, male, homeless aid].

Supervision

Supervision was another important source of support for many interviewees. It was typically provided once a month and in the form of group supervision. Some participants described larger time periods for supervision, e.g. once every 6 or 8 weeks. Two workers indicated that group supervision was not available to them. For the majority of the workers, supervision was perceived as helpful for self-reflection, knowledge exchange and for learning new tools and work methods:

“I find supervision helpful because then somebody external comes along and sometimes you’re sort of a bit out on ledge when you’re just doing things yourself. And that just gives another perspective, which is often simply a relief.” [#3, female, homeless aid].

However, dissatisfaction with supervision was also occasionally expressed, e.g. that it had to be postponed or cancelled due to understaffing, or that group supervision was not welcomed by all team members. The availability of individual supervision varied: for most of the interviewees, this form of supervision was not available. One worker stated that individual supervision was generally available, another said that it was only available for managers, and two interviewees declared that it was only available in extremely worrying situations (e.g. stalking, sexual abuse).

Training courses

The provision of training courses was another frequently mentioned source of support. Courses covered a range of topics, e.g. legal aspects, de-escalation techniques, counselling know-how and management skills. In some cases, there was a training budget available for each employee, and employees could select and request training themselves:

“I am offered [training], internally or sometimes I can even make suggestions and organise things myself. And taking part in training with other providers is also approved and financed. That’s important.” [#12, male, refugee aid].

Support from other institutions

Single interviewees described further sources of support within their institutions, e.g. support provided by experts from the human resources department or the sponsoring association. With respect to support from external sources, three workers stated that there were no other institutions to which they could turn for advice. The other workers described several sources of support in the form of network centres and counselling services (e.g. for issues like violence, drugs, debt and flight). Furthermore, sources of support also included federal associations, lawyers, doctors, psychologists, training providers, former professors and colleagues, volunteers or professionals with similar tasks who could be asked for advice. Cooperation with other institutions was generally perceived as supportive, as it allowed the interviewees to pass clients on to other parties if they were not able to provide support in all necessary aspects:

“A large part of the work is actually that we look to see where there are places where we can send our people if they need special or concrete help.” [#15, male, refugee aid].

Support in private life

Employees also described sources of support in their private lives provided by partners, families, friends and roommates. Support was particularly noticed when people in the family or circle of friends had a refugee background themselves and could assist with translation or interpreting tasks. Conversations with family members were also generally perceived as supportive:

“Well, in my family we talk about the topic of homelessness a lot (…). My partner is also very interested in what I do and asks about it, so does my family.” [#8, male, homeless aid].

Workplace health promotion

Comments on workplace health promotion concerned the availability of health promotion offers as well as the further needs and wishes of employees.

Available health promotion offers

Overall, six respondents declared that no health promotion offers were available at their workplace, although some of them indicated the possibility of available health promotion offers that were unknown to them, e.g. due to the size of their organisations:

“Maybe it does exist. But I think I just don’t know anything about it. Around Germany, they [the institutions] have up to 14,000 workers, and (…) a lot of roles and facilities and it is sometimes not really clear and you don’t always find out about everything.” [#14, female, refugee aid].

Other workers reported several health promotion activities which consisted of individual offers rather than systematic workplace health management. With regard to behavioural measures, eleven interviewees stated that health days were organised every year or every 2 years. Two workers stated that there were massage services offered. These were either cross-departmental health days for all employees or organised individually by smaller teams. Moreover, respondents mentioned that courses and workshops were offered on different topics, ranging from stress management, mindfulness, yoga and relaxation to back training, healthy cooking and acupuncture. Quick relaxation and sports exercises were also occasionally organised, e.g. in the form of active lunch breaks. Furthermore, one respondent said that there was a volleyball group and another stated that there was an intern who had given the team Kung Fu lessons.

With respect to structural measures, four interviewees reported that companies offered medical examinations, vaccinations and funding for glasses at work. In addition, five workers reported funding for the use of gyms and two for fruit purchases at work. The implementation of a risk assessment on mental stress, regular health and safety information, funding for participation in company runs, and a service bike offer were described by one worker each.

In terms of workers’ experiences with health promotion offers, some employees stated that they had already used the offers or planned on doing so in due course. Six workers who had not used any offer so far indicated various reasons for not having done so, e.g. a lack of interest in existing offers and lacking motivation after work. In addition, the preference to take part in sport offers privately rather than in the work context was expressed by seven employees:

“I mean, doing exercise activities with my colleagues isn’t really my thing. Doing Thai Chi on the roof with people, I would find that a bit weird. Because I do my own exercise.” [#5, female, refugee aid].

Two respondents cited shift work as a major obstacle to participation in health promotion activities. Moreover, excessive workload and a resulting lack of time were described. One worker said that courses took place at unfavourable times and two commented that they took place in unfavourable locations (e.g. offers held in headquarters, but not in branch offices). Furthermore, the unclear and time-consuming registration process was noticed. Three respondents said that they would have to initiate and organise health promotion activities themselves, since this was not organised by the institutions.

Needs and wishes for health promotion offers

In terms of behavioural measures, several respondents stated their general interest in sports offers and in the organisation of company sports groups (e.g. a running group after work):

“Doing some sort of exercise activities with colleagues, some communal activities. Just that we do something to release a bit of energy and have a laugh, laughing is important.” [#7, female, homeless aid].

Requests for regular, company-wide training courses were also made. Such courses should consist of a mixture of theory and practice and deal with various topics, e.g. back therapy training, stress management, relaxation techniques, qigong, yoga, body awareness, de-escalation and self-care. Three respondents particularly wanted activities to be offered during their work hours. Moreover, easily accessible activities at different times of the day were preferred and considered necessary for coordination with shift work:

“You would really have to be able to choose when you go. (…) That you really can go in the mornings, maybe in the evenings, because, you know, we do a lot of shift work.” [#23, male, homeless aid].

Four workers reported their desire for massages at work and two wished for a massage chair. Regarding structural measures, financial support for private hobbies and discounts for nearby gyms were desired. Moreover, further supervision, contact to lawyers for legal questions and regular medical examinations were stated. In addition, one respondent introduced the idea of a social worker counsellor working in the organisation’s facilities (instead of hard-to-reach external supervision):

“If someone were to come into the facility and simply offer an open space to talk, somewhere you can simply drop in. Someone that doesn’t work here themselves, but who you could go to and simply talk about things, especially during working hours. A social worker for social workers.” [#6, female, refugee aid].

With regard to the work environment, separate rooms for exercise and relaxation activities as well as rest rooms for breaks were requested. Two workers indicated their satisfaction with the available health promotion offers and stated that they had no need for further offers.

To our knowledge, this is the first study to empirically explore the coping strategies, support sources and health promotion offers available to German social workers in the growing work areas of refugee and homeless aid. By conducting qualitative interviews with 26 social workers in these fields, we were able to gain important new insights into these topics and extend current evidence.

Some of the problem-focused coping strategies identified in this study have previously been reported for social workers, such as the strategies of setting limits and boundaries in contact with clients or with regard to work and private life [ 5 , 16 , 17 ]. Moreover, acquiring knowledge (e.g. through training activities) in order to manage work-related stress has also been stated before by German refugee aid workers [ 27 ]. In addition to this, our study uncovered further problem-oriented strategies that have received little attention so far, such as strategies related to employees’ work organisation and time management. Time management coping strategies were described as helping workers prioritise and make the best use of their time, which was particularly important in view of their multiple work tasks and restricted time resources.

Another important coping strategy revealed in our study was the search for social support. This strategy emerged both in the context of problem-oriented coping strategies (seeking instrumental support from colleagues and superiors to deal with stressful situations and concrete problems at work) and emotion-oriented coping strategies (seeking informal social support from family and friends to alleviate negative emotions). In general, the search for social support is a frequently used coping strategy, and protective links between social support and health are well documented [ 48 , 49 ]. The finding is consistent with previous research in which social support represented an essential job resource for staff in refugee and homeless aid [ 6 , 50 ].

In addition, a notable finding of our study is that some interviewees had started psychotherapy to better cope with their job demands and associated strains. The fact that psychotherapy was initiated by the interviewees themselves points to a high level of suffering among these workers, which was emphasized by the workers themselves. In accordance with this, previous studies have shown a high prevalence of long-term psychological strain reactions among social workers, including depressive moods and burnout [ 9 , 13 , 51 , 52 ]. The result is somewhat alarming, as it suggests a perceived lack of possibilities for the workers to address their problems in the workplace and receive adequate help, e.g. through individual supervision. In fact, individual supervision was unavailable to most workers in our study. Earlier research suggests that the availability of individual supervision may vary across different settings and countries. For example, in a recent study on homeless aid in the UK, 83% of the frontline workers had access to individual supervision [ 26 ].

With respect to the reported emotion-oriented coping strategies, being active (e.g. exercising, taking walks outdoors) and pursuing leisure activities were underlined by many workers as central coping behaviours. The importance of these strategies has been outlined before [ 5 , 6 , 16 , 17 ]. Moreover, actively organising their leisure time helped the workers to get away from work. Evidence suggests that social workers often find it difficult to switch off from work [ 13 , 17 ], which further explains their use of coping strategies that enable them to detach and recover from job stress.

Further emotion-focused coping strategies employed by the interviewees were the strategy of avoiding presenteeism and consciously taking self-care actions. Similarly, the use of self-care strategies (e.g. diet changes, improvement in sleep hygiene, relaxation) was found to be a functional coping strategy [ 21 ] which was also used by employees in homeless aid [ 6 ].

Notably, several emotion-oriented coping strategies used by the workers in our study involved cognitive components, e.g. gaining mental distance from work, accepting unchangeable situations and focusing on positive experiences. In earlier studies with social workers, similar cognitive coping efforts were described, e.g. with regard to the acceptance of clients’ undesirable behaviour without taking it personally [ 19 ] and of their boundaries of influence [ 18 ]. The use of cognitive coping strategies may be particularly efficacious for social workers when they encounter problems that cannot be changed directly (e.g. political laws). However, making use of such strategies is also demanding, as it firstly requires the workers’ ability to reflect problems on a meta level.

In earlier research, most of the coping strategies employed by social workers were classified as emotion-focused [ 9 ]. In comparison, employees in our study used both problem-oriented and emotion-oriented strategies, although a slight tendency towards the use of more emotion-oriented strategies was observable. Referring back to the theoretical definition of coping provided by Lazarus and Folkman [ 36 , 37 ], the variety of identified coping strategies underpins the notion that most individuals use both problem-oriented and emotion-oriented coping strategies to deal with stressful events [ 36 ].

Regarding the identified sources of support for social workers, most of them were linked to workplace social support [ 40 ], e.g. provided by team members, supervisors, external persons and institutions. This result underlines the importance of social interaction for the working group. It also suggests that the workers may already have some sources of support available in the work setting. At the same time, however, our study sheds light on potential for improvement, e.g. with regard to team meetings and supervision being postponed, too short or too superficial to provide help for complex problems. Our results are consistent with earlier research indicating that social workers (especially those with severe strain reactions) did not feel sufficiently supported by supervisors [ 13 ]. External supervision and consulting are important tools for reflecting on one’s work methods and stressors, and have shown protective effects on the health [ 53 ] and job satisfaction [ 25 ] of social workers. Conversely, a recent qualitative study suggested that inadequate supervision and a lack of supervisor support may play a critical role in the development of long-term strain among social workers [ 13 ]. Summarising the above, the need for adequate supervision for social workers in homeless and refugee aid has been raised before [ 9 , 13 ] and is strongly reinforced by our results.

With regard to workplace health promotion, a relevant finding of our study is that several employees were unaware of health promotion offers at their workplaces, although some of them indicated that such offers could possibly exist. Furthermore, several workers named individual health promotion offers, but none of them described a systematic workplace health management. On the one hand, this suggests that there may be little systematic approaches to workplace health management within the organisations so far. On the other hand, the findings may also point to a lack of information on the part of the interviewees, suggesting that health promotion offers may not be advertised properly and that communication flows within the organisations need to be improved. Many of the cited needs for behavioural and structural health promotion measures are consistent with the results from earlier research. For example, in terms of behavioural measures, the respondents wished for regular and company-wide training courses on a range of topics, which has been similarly revealed in previous studies [ 16 , 50 ]. A recent study showed that over one fifth of frontline workers in homeless services never had access to relevant training, e.g. relating to suicide, self-harm and mental health [ 26 ]. Some training options were especially scarce, e.g. training on trauma and domestic violence, which one third of the workers had never received. Needs in terms of structural measures concerned offers for supervision and counselling as well as changes in the work environment. Likewise, in a recent study, it was demanded that employees should be provided with adequate facilities to enable relaxation during their breaks [ 13 ].

Implications

From the results of our study, some implications for research can be drawn. In terms of research-related implications, quantitative studies with higher sample sizes should be carried out to generalise and quantify our findings, e.g. regarding the potentially positive effects of coping and the status quo of workplace health promotion for social workers in refugee and homeless aid. In future studies, it would be interesting to compare the support sources and health promotion offers for social workers in different work settings (e.g. organisations of different types and sizes, with independent and public sponsors, and in rural and urban structures). This could help to gain a deeper understanding of the beneficial and impeding factors for implementing health promotion offers.

Practical implications can also be derived (Table 5 ). Our findings indicate that workplace interventions should be carried out aiming at empowering social workers to further expand upon their coping strategies. In organised courses and workshops, employees could acquire relevant skills and learn about further ways of coping with job stress in a resilient manner. With respect to the development of support sources, demands for greater support and expanded supervision for social workers have previously been made [ 53 ] and are strongly reinforced by our findings. Supervision is highly valuable, as it promotes reflection, support and evidence-based expertise [ 53 ]. To support employees in dealing with their emotional demands, easy and low-threshold access to qualified supervision must be provided for all workers in the form of individual and/or group supervision. This seems particularly relevant in view of the stress factors and secondary/post-traumatic stress in social workers serving refugees and homeless clients [ 14 , 15 ]. In the same vein, it is important to inform the workers well about the usefulness of supervision, especially those who are still inexperienced and unsure about using this offer. Moreover, team support within the institutions should be nurtured and upheld. For this purpose, the provision of regular meetings with sufficient time for case consulting and enough room to spend breaks together with colleagues would be useful. Emphasis should also be placed on networking, regular exchange and cooperation with other counselling services which can provide support as neutral entities.

In view of the diverse needs for health promotion stated by the workers, our findings provide a useful starting point for planning needs-based health promotion offers. Suitable structural measures may address the work organisation (e.g. in terms of ensuring reliable work hours and a manageable workload). They should also aim at improving the work environment, e.g. by providing more rooms for rest and recovery. With respect to behavioural measures, training courses on work- and health-related topics (exercise, relaxation, de-escalation, violence, etc.) are recommended. For example, since workers in our study mentioned aggressive behaviour of clients, the availability of training courses on de-escalation and non-violent communication may be particularly helpful for those who encounter such problems at work. Our results indicate that initial health promotion offers are already available at many organisations, meaning that future interventions can be based on existing offers and can expand upon them, taking the workers’ needs into account. Employees should be given opportunities to make flexible use of health promotion offers, e.g. during work hours and at different locations in order to improve coordination with shift work, which is often a major obstacle in participation. Since health promotion offers may not always be well-promoted, this highlights the importance of systematic and target-oriented advertisement within the organisations. After all, politicians at a higher level also have a responsibility for creating a framework and providing sufficient resources to promote these crucial fields of social work, so that adequate programs can be implemented at company level.

Strengths and limitations

A particular strength of this study is that the views of social workers were assessed in a heterogeneous sample (e.g. in terms of age, work experience, etc.). Thereby, we were able to capture different perspectives and broadly map the topics of interest. Considering the explorative character of the study, a sufficient number of workers was included in order to attain data saturation [ 54 ]. Further strengths of this study are the consistent orientation towards and application of recognized field practices, e.g. the data analysis according to Mayring’s qualitative content analysis [ 44 ]. To improve the internal quality of the study, we used rich descriptions as well as numerous direct quotes to describe our results [ 55 ], and applied the international checklist “COREQ” [ 47 ]. Moreover, all results were compared to empirical references and to the theoretical framework [ 56 ].

Some limitations of the study should also be noted. As in any qualitative study, the interviewees’ responses may have been influenced by the lack of anonymity between the workers and the interviewer as well as by social desirability tendencies. Selection effects cannot be ruled out either. For example, all respondents spoke fluent German and were rather young; results could be different for older employees or employees of other nationalities. Qualitative research captures the subjective perspectives and truths of the respondents. The interview sample is not representative of the general population of social workers, and the results are not generalisable to other settings or time periods. The temporal context of the study period should also be noted: the interviews were conducted in autumn 2017, when immigration in Germany slowly subsided, leading to restructuring measures and closures of institutions. In homeless aid, employees experienced a steady increase in homelessness and changes in the clientele in terms of, for example, gender and origin [ 57 ]. Such recent developments should generally be kept in mind with regard to their potential impact on our results.

The results of the study provide novel insights into the coping strategies employed by social workers in refugee and homeless aid and into the available support sources and workplace health promotion. On the one hand, the findings show that social workers use multiple coping strategies and have access to different support sources in the workplace, helping them to deal with their job demands and regulate their emotional responses. On the other hand, the results suggest that certain needs for support among employees are not yet covered, and that systematic workplace health promotion appears to be scarce within the organisations. The identified wishes of the workers for behavioural and structural measures are particularly relevant for health promotion, as they indicate diverse areas and starting points for policy makers and organisations to design needs-based health promotion interventions for social workers in refugee and homeles aid.

Availability of data and materials

The datasets are not publicly available due to German national data protection regulations. They are available from the corresponding author upon reasonable request.

United Nations High Comissioner for Refugees. Global trends: Forced displacement in 2018. Geneva: UNHCR: The UN Refugee Agency; 2019.

Google Scholar

BAG Wohnungslosenhilfe e.V. Zahl der Wohnungslosen. Available online: http://www.bagw.de/de/themen/zahl_der_wohnungslosen/index.html (Accessed on 11.09.2019).

Bundesamt für Migration und Flüchtlinge (BAMF). Das Bundesamt in Zahlen 2019. Nürnberg: Bundesamt für Migration und Flüchtlinge; 2020.

Pell M. Sekundärtraumatisierung bei Helferinnen im Umgang mit traumatisierten Flüchtlingen. Vienna: University Vienna; 2013.

Lakeman R. How homeless sector workers Deal with the death of service users: a grounded theory study. Death Stud. 2011;35(10):925–48.

PubMed Google Scholar

Lusk M, Terrazas S. Secondary trauma among caregivers who work with Mexican and central American refugees. Hisp J Behav Sci. 2015;37(2):257–73.

Stiftung B. Willkommenskultur im “Stresstest”. Einstellungen in der Bevölkerung 2017 und Entwicklungen und Trends seit 2011/12. Gütersloh: Bertelsmann Stiftung; 2017.

Gerull S. “UNANGENEHM”, “ARBEITSSCHEU”, “ASOZIAL”. Zur Ausgrenzung von wohnungslosen Menschen. Aus Politik und Zeitgeschichte(APuZ). 2018;25-26(18):30–36.

Wirth T, Mette J, Prill J, Harth V, Nienhaus A. Working conditions, mental health and coping of staff in social work with refugees and homeless individuals: a scoping review. Health Social Care Community. 2019;27(4):e257–e69.

Coyle D, Edwards D, Hannigan B, Fothergill A, Burnard P. A systematic review of stress among mental health social workers. Int Soc Work. 2005;48(2):201–11.

McFadden P, Campbell A, Taylor B. Resilience and burnout in child protection social work: individual and organisational themes from a systematic literature review. Brit J Soc Work. 2014;45(5):1546–63.

Stalker CA, Mandell D, Frensch KM, Harvey C, Wright M. Child welfare workers who are exhausted yet satisfied with their jobs: how do they do it? Child Fam Soc Work. 2007;12(2):182–91.

Wirth T, Mette J, Nienhaus A, Schillmöller Z, Harth V, Mache S. “This Isn’t Just about Things, It’s about People and Their Future”: A qualitative analysis of the Working Conditions and Strains of Social Workers in Refugee and Homeless Aid. Int J Environ Res Public Health. 2019;16(20):3858.

PubMed Central Google Scholar

Kim YJ. Secondary traumatic stress and burnout of north Korean refugees service providers. Psych Investigation. 2017;14(2):118.

Waegemakers Schiff J, Lane A. BURNOUT AND PTSD IN WORKERS IN THE HOMELESS SECTOR IN CALGARY. 2016. Available online: http://calgaryhomeless.com/content/uploads/Calgary-Psychosocial-Stressors-Report.pdf (Accessed on 03.11.2019).

Guhan R, Liebling-Kalifani H. The experiences of staff working with refugees and asylum seekers in the United Kingdom: a grounded theory exploration. J Immigr Refug Stud. 2011;9(3):205–28.

Kidd SA, Miner S, Walker D, Davidson L. Stories of working with homeless youth: on being “mind-boggling”. Child Youth Serv Rev. 2007;29(1):16–34.

Ferris LJ, Jetten J, Johnstone M, Girdham E, Parsell C, Walter ZC. The Florence nightingale effect: organizational identification explains the peculiar link between Others’ suffering and workplace functioning in the homelessness sector. Front Psychol. 2016;7:16.

PubMed PubMed Central Google Scholar

Kosny AA, Eakin JM. The hazards of helping: work, mission and risk in non-profit social service organizations. Health Risk Soc. 2008;10(2):149–66.

Sundqvist J, Ghazinour M, Padyab M. Coping with stress in the forced repatriation of unaccompanied asylum-seeking refugee children among Swedish police officers and social workers. Psychology. 2017;08(01):97–118.

Lian Y, Gu Y, Han R, Jiang Y, Guan S, Xiao J, et al. Effect of changing work stressors and coping resources on psychological distress. J Occup Environ Med. 2016;58(7):e256–e63.

Anderson DG. Coping strategies and burnout among veteran child protection workers. Child Abuse Negl. 2000;24(6):839–48.

CAS PubMed Google Scholar

Koeske GF, Kirk SA, Koeske RD. Coping with job stress: which strategies work best? J Occup Organ Psychol. 1993;66(4):319–35.

Robinson K. Voices from the front line: social work with refugees and asylum seekers in Australia and the UK. Brit J Soc Work. 2013;44(6):1602–20.

Chapleau A, Seroczynski AD, Meyers S, Lamb K, Haynes S. Occupational therapy consultation for case managers in community mental health. Prof Case Manag. 2011;16(2):71–9.

Lemieux-Cumberlege A, Taylor EP. An exploratory study on the factors affecting the mental health and well-being of frontline workers in homeless services. Health Soc Care Community. 2019;27(4):e367–e78.

Grimm T, Georgiadou E, Silbermann A, Junker K, Nisslbeck W, Erim Y. Psychische und kontextuelle Belastungen, Motivationsfaktoren und Bedürfnisse von haupt- und ehrenamtlichen Flüchtlingshelfern. Psychother Psych Med. 2017;67(08):345–51.

Conn VS, Hafdahl AR, Cooper PS, Brown LM, Lusk SL. Meta-analysis of workplace physical activity interventions. Am J Prev Med. 2009;37(4):330–9.

Proper KI, Koning M, Van der Beek AJ, Hildebrandt VH, Bosscher RJ, van Mechelen W. The effectiveness of worksite physical activity programs on physical activity, physical fitness, and health. Clin J Sport Med. 2003;13(2):106–17.

Maes L, Van Cauwenberghe E, Van Lippevelde W, Spittaels H, De Pauw E, Oppert JM, et al. Effectiveness of workplace interventions in Europe promoting healthy eating: a systematic review. Eur J Pub Health. 2012;22(5):677–82.

Ni Mhurchu C, Aston LM, Jebb SA. Effects of worksite health promotion interventions on employee diets: a systematic review. BMC Public Health. 2010;10:62.

Kuoppala J, Lamminpää A, Husman P. Work health promotion, job well-being, and sickness absences—a systematic review and Meta-analysis. J Occup Environ Med. 2008;50(11):1216–27.

Odeen M, Magnussen LH, Mæland S, Larun L, Eriksen HR, Tveito TH. Systematic review of active workplace interventions to reduce sickness absence. Occup Med. 2013;63(1):7–16.

CAS Google Scholar

Chapman LS. Meta-evaluation of worksite health promotion economic return studies: 2012 update. Am J Health Promot. 2012;26(4):1–12.

Bräunig D, Haupt J, Kohstall T, Kramer I, Pieper C, Schröer S. iga. Report 28: Wirksamkeit und Nutzen betrieblicher Prävention. Berlin: Initiative Gesundheit und Arbeit (iga); 2015.

Folkman S, Lazarus RS. An analysis of coping in a middle-aged community sample. J Health Soc Behav. 1980;21(3):219–39.

Folkman S. Personal control and stress and coping processes: a theoretical analysis. J Pers Soc Psychol. 1984;46(4):839–52.

Pinquart M, Silbereisen RK. Coping with increased uncertainty in the field of work and family life. Int J Stress Manag. 2008;15(3):209–21.

Richter A, Näswall K, De Cuyper N, Sverke M, De Witte H, Hellgren J. Coping with job insecurity: exploring effects on perceived health and organizational attitudes. Career Dev Int. 2013;18(5):484–502.

Kossek EE, Pichler S, Bodner T, Hammer LB. Workplace social support and work-family conflict: a meta-analysis clarifying the influence of general and work-family-specific supervisor and organizational support. Pers Psychol. 2011;64(2):289–313.

Burton J. WHO healthy workplace framework and model: background and supporting literature and practices. Geneva: World Health Organization; 2010.

Franzkowiak P. Prävention und Krankheitsprävention. In: Bundeszentale für gesundheitliche Aufklärung (BZgA), editor. Leitbegriffe der Prävention und Gesundheitsförderung. Köln: Bundeszentale für gesundheitliche Aufklärung (BZgA); 2011. p. 437–47.

Creswell JW, Poth CN. Qualitative inquiry and research design: choosing among five approaches: sage publications; 2016.

Mayring P. Qualitative Inhaltsanalyse [Qualitative Content Analysis]. Forum Qual Soc Res. 2000;1(2) Available online: http://nbn-resolving.de/urn:nbn:de:0114-fqs0002204 (Accessed on 25.11.2019).

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

VERBI Software Consult Sozialforschung GmbH. MAXQDA 12: Reference Manual: VERBI Software. Consult. Sozialforschung. GmbH; 2014. Available online: http://www.maxqda.com/download/manuals/MAX12_manual_eng.pdf (Accessed on 10.09.2019).

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.

Penley JA, Tomaka J, Wiebe JS. The Association of Coping to physical and psychological health outcomes: a Meta-analytic review. J Behav Med. 2002;25(6):551–603.

Stansfeld S, Candy B. Psychosocial work environment and mental health – a meta-analytic review. Scand J Work Environ Health. 2006;32:443–62.

Mowbray CT, Thrasher SP, Cohen E, Bybee D. Improving Social Work Practice with Persons Who are Homeless and Mentally Ill. J Sociol Soc Welf. 1996;23(4):3–24.

Waegemakers Schiff J, Lane AM. PTSD symptoms, vicarious traumatization, and burnout in front line Workers in the Homeless Sector. Commun Mental Health J. 2019;55(3):454–62.

Sundqvist J, Hansson J, Ghazinour M, Ogren K, Padyab M. Unaccompanied asylum-seeking refugee Children's forced repatriation: social Workers’ and police Officers’ health and job characteristics. Glob J Health Sci. 2015;7(6):215–25.

Robinson K. Supervision found wanting: experiences of health and social Workers in non-Government Organisations Working with refugees and asylum seekers. Practice. 2013;25(2):87–103.

Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82.

van Nes F, Abma T, Jonsson H, Deeg D. Language differences in qualitative research: is meaning lost in translation? Eur J Ageing. 2010;7(4):313–6.

Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001;358(9280):483–8.

Neupert P. Wohnungsnot im Wandel? Aktuelle Daten und Entwicklungen aus dem Dokumentationssystem zur Wohnungslosigkeit. wohnungslos. 2018;4:122–8.

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Acknowledgements

We’d like to thank all institutions and employees who participated in the interviews. Moreover, we thank the students Gabriel David Westermann, Friederike Seemann, Jerrit Prill, and Lara Steinke for their support in the recruitment of interview participants and data transcription.

This research was funded by the Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW; non-profit organisation which is part of the German social security system), Hamburg, Germany. The funder had no role in the study design, data collection, data analysis and interpretation, preparation of the manuscript and decision to submit the paper for publication.

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JM, TW, AN, VH, and SM planned the study and study design. JM and TW carried out the qualitative study and analysed the data. JM, TW, and SM interpreted the data. JM drafted the manuscript. TW, AN, VH, and SM reviewed the manuscript and contributed substantially to its revision. All authors read and approved the final version of the manuscript.

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Relevant interview guideline questions.

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Mette, J., Wirth, T., Nienhaus, A. et al. “I need to take care of myself”: a qualitative study on coping strategies, support and health promotion for social workers serving refugees and homeless individuals. J Occup Med Toxicol 15 , 19 (2020). https://doi.org/10.1186/s12995-020-00270-3

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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

Andersen MF, Nielsen KM, Brinkmann S. Meta-synthesis of qualitative research on return to work among employees with common mental disorders. Scand J Work Environ Health. 2012;38(2):93–104.

Article Google Scholar

Waddell G, Burton AK. Is work good for your health and wellbeing? London, UK: The Stationery Office; 2006.

Google Scholar

Aylward SM. Overcoming barriers to recovery and return to work: towards behavioral and cultural change. In: Schultz I, Gatchel R, editors. Handbook of return to work. Boston, MA: Springer; 2016. https://doi.org/10.1007/978-1-4899-7627-7_7 .

Chapter Google Scholar

McLeod CB, Reiff E, Maas E, Bültmann U. Identifying return-to-work trajectories using sequence analysis in a cohort of workers with work-related musculoskeletal disorders. Scand J Work Env Hea. 2018;44(2):147–55. https://doi.org/10.5271/sjweh.3701 .

Bültmann U, Sherson D, Olsen J, Hansen CL, Lund T, Kilsgaard J. Coordinated and tailored work rehabilitation: a randomized controlled trial with economic evaluation undertaken with workers on sick leave due to musculoskeletal disorders. J Occup Rehabil. 2009;19(1):81–93.

Palmer KT, Harris EC, Linaker C, Barker M, Lawrence W, Cooper C, Coggon D. Effectiveness of community-and workplace-based interventions to manage musculoskeletal-related sickness absence and job loss: a systematic review. Rheumatology. 2012;51(2):230–42. https://doi.org/10.1093/rheumatology/ker086 .

Roelen CA, Norder G, Koopmans PC, Van Rhenen W, Van Der Klink JJ, Bültmann U. Employees sick-listed with mental disorders: who returns to work and when? J Occup Rehabil. 2012;22(3):409–17. https://doi.org/10.1007/s10926-012-9363-3 .

Article CAS Google Scholar

Steenstra IA, Anema JR, Van Tulder MW, Bongers PM, De Vet HC, Van Mechelen W. Economic evaluation of a multi-stage return to work program for workers on sick-leave due to low back pain. J Occup Rehabil. 2006;16(4):557–78. https://doi.org/10.1007/s10926-006-9053-0 .

Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8–20. https://doi.org/10.1016/j.spinee.2007.10.005 .

van Duijn M, Eijkemans MJ, Koes BW, Koopmanschap MA, Burton KA, Burdorf A. The effects of timing on the cost-effectiveness of interventions for workers on sick leave due to low back pain. Occup Environ Med. 2010;67(11):744–50. https://doi.org/10.1136/oem.2009.049874 .

Norwegian Directorate of Health. Sykmelderveileder. Nasjonal veileder. [Guidance for sickness certification. National guideline]. https://www.helsedirektoratet.no/veiledere/sykmelderveileder . Accessed 19.03.2024.

Holmgren K, Ivanoff SD. Supervisors’ views on employer responsibility in the return to work process. A focus group study. J Occup Rehabil. 2007;17(1):93–106.

Mazza D, Brijnath B, Singh N, Kosny A, Ruseckaite R, Collie A. General practitioners and sickness certification for injury in Australia. BMC Fam Pract. 2015;16:100. https://doi.org/10.1186/s12875-015-0307-9 .

Article PubMed Central Google Scholar

Ose SO, Dyrstad K, Brattlid I, Slettebak R, Jensberg H, Mandal R, Lippestad J, Pettersen I. Oppfølging av sykmeldte–fungerer dagens regime? [Follow-up of sick-listed – does today’s regime work?]. Trondheim, NO: SINTEF; 2013.

Shaw W, Hong QN, Pransky G, Loisel P. A literature review describing the role of return-to-work coordinators in trial programs and interventions designed to prevent workplace disability. J Occup Rehabil. 2008;18(1):2–15.

MacEachen E, McDonald E, Neiterman E, et al. Return to work for Mental Ill-Health: a scoping review exploring the impact and role of return-to-work coordinators. J Occup Rehabil. 2020;30:455–65. https://doi.org/10.1007/s10926-020-09873-3 .

Article CAS PubMed Central Google Scholar

Norwegian Ministry of Labour and Social Affairs. (2016). NAV i en ny tid – for arbeid og aktivitet. Meld. St. 33 (2015–2016). [NAV in a new age – for work and activity] Retrieved from https://www.regjeringen.no Accessed 19.03.2024.

Vogel N, Schandelmaier S, Zumbrunn T, Ebrahim S, de Boer WE, Busse JW, Kunz R. Return-to‐work coordination programmes for improving return to work in workers on sick leave. Cochrane Database Syst Rev. 2017(3). https://doi.org/10.1002/14651858.CD011618.pub2 .

Dol M, Varatharajan S, Neiterman E, McKnight E, Crouch M, McDonald E, Malachowski C, Dali N, Giau E, MacEachen E. Systematic review of the impact on return to work of return-to-work coordinators. J Occup Rehabil. 2021;31(4):675–98.

Markussen S, Røed K, Schreiner RC. Can compulsory dialogues nudge sick-listed workers back to work? Econ J. 2018;128(610):1276–303. https://doi.org/10.1111/ecoj.12468 .

Nossen JP, Brage S. Aktivitetskrav Og midlertidig stans av sykepenger - hvordan påvirkes sykefraværet? [Activity demands and temporary stop in paid sick leave – how is sickness absence affected?]. Arbeid Og Velferd. 2015;3.

Mandal R, Jakobsen Ofte H, Jensen C, Ose SO. Hvordan fungerer arbeidsavklaringspenger (AAP) som ytelse og ordning? [How does work assessment allowance work as a benefit and arrangement?]. Trondheim, Norway: SINTEF; 2015.

Foldal VS, Solbjør M, Standal MI, Fors EA, Hagen R, Bagøien G. Mfl. Barriers and facilitators for implementing motivational interviewing as a return to work intervention in a Norwegian Social Insurance setting: a mixed methods process evaluation. J Occup Rehabil. 2021;31(4):785–95.

Standal MI, Foldal VS, Hagen R, Aasdahl L, Johnsen R, Fors EA. Mfl. Health, Work, and Family strain–psychosocial experiences at the early stages of long-term sickness absence. Front Psychol. 2021;12:596073.

Foldal VS, Standal MI, Aasdahl L, Hagen R, Bagøien G, Fors EA. Mfl. Sick-listed workers’ experiences with motivational interviewing in the return to work process: a qualitative interview study. BMC Public Health. 2020;20(1):1–10.

Aasdahl L, Foldal VS, Standal MI, Hagen R, Johnsen R, Solbjør M. Mfl. Motivational interviewing in long-term sickness absence: study protocol of a randomized controlled trial followed by qualitative and economic studies. BMC Public Health. 2018;18(1):1–8.

Norwegian Labour and Welfare Administration. Sickness benefits for employees. 2023. Retrieved from https://www.nav.no/en/home/benefits-and-services/Sickness-benefit-for-employees . Accessed 19.03.2024.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

Shaw WS, Robertson MM, Pransky G, McLellan RK. Employee perspectives on the role of supervisors to prevent workplace disability after injuries. J Occup Rehabil. 2003;13(3):129–42.

Jansen J, van Ooijen R, Koning PWC, et al. The role of the employer in supporting work participation of workers with disabilities: a systematic literature review using an Interdisciplinary Approach. J Occup Rehabil. 2021;31:916–49. https://doi.org/10.1007/s10926-021-09978-3 .

Buys NJ, Selander J, Sun J. Employee experience of workplace supervisor contact and support during long-term sickness absence. Disabil Rehabil. 2019;41(7):808–14.

Buys N, Wagner S, Randall C, Harder H, Geisen T, Yu I, Hassler B, Howe C, Fraess-Phillips A. Disability management and organizational culture in Australia and Canada. Work. 2017;57(3):409–19.

Kristman VL, Shaw WS, Boot CR, Delclos GL, Sullivan MJ, Ehrhart MG. Researching complex and multi-level workplace factors affecting disability and prolonged sickness absence. J Occup Rehabil. 2016;26(4):399–416.

Reme SE. Common Mental disorders and work: barriers and opportunities. Handbook of disability, work and health. 2020:467 – 81. In: Bültmann U, Siegrist J, editors. Handbook of disability, work and health. Handbook Series in Occupational Health Sciences. Volume 1. Cham, CH: Springer; 2020.

Karlsson E, Legitimacy. and comprehensibility of work-related assessments and official decisions within the sickness insurance system [Internet] [PhD dissertation]. [Linköping]: Linköping University Electronic Press; 2022. (Linköping University Medical Dissertations). https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-183867 .

Kristman VL, Boot CR, Sanderson K, Sinden KE, Williams-Whitt K. Implementing best practice models of return to work. Handbook of disability, work and health. 2020:1–25. In: Bültmann U., Siegrist J, editors Handbook of Disability, Work and Health. Handbook Series in Occupational Health Sciences, vol 1. Cham, CH: Springer; 2020.

Christian Ståhl EA, Karlsson J, Sandqvist G, Hensing S, Brouwer EF, Ellen MacEachen. Social insurance literacy: a scoping review on how to define and measure it. Disabil Rehabil. 2021;43(12):1776–85. https://doi.org/10.1080/09638288.2019.1672111 .

Karlsson EA, Hellgren M, Sandqvist JL, et al. Social Insurance Literacy among the sick-listed—A study of clients’ comprehension and self-rated system comprehensibility of the Sickness Insurance System. J Occup Rehabil. 2024. https://doi.org/10.1007/s10926-023-10166-8 .

Corbière M, Mazaniello-Chézol M, Bastien MF, et al. Stakeholders’ role and actions in the return-to-work process of workers on sick-leave due to Common Mental disorders: a scoping review. J Occup Rehabil. 2020;30:381–419. https://doi.org/10.1007/s10926-019-09861-2 .

Müssener U, Ståhl C, Söderberg E. Does the quality of encounters affect return to work? Lay people describe their experiences of meeting various professionals during their rehabilitation process. Work. 2015;52(2):447–55.

Andersen MF, Nielsen K, Brinkmann S. How do workers with common mental disorders experience a multidisciplinary return-to-work intervention? A qualitative study. J Occup Rehabil. 2014;24(4):709–24.

Haugli L, Maeland S, Magnussen LH. What facilitates return to work? Patients experiences 3 years after occupational rehabilitation. J Occup Rehabil. 2011;21(4):573–81.

Scharf J, Angerer P, Müting G, Loerbroks A. Return to work after common mental disorders: a qualitative study exploring the expectations of the involved stakeholders. Int J Environ Res Public Health. 2020;17(18):6635.

Saxon D, Firth N, Barkham M. The relationship between therapist effects and therapy delivery factors: therapy modality, dosage, and non-completion. Adm Policy Ment Health Ment Health Serv Res. 2017;44(5):705–15.

Wampold BE, Bolt DM. Therapist effects: Clever ways to make them (and everything else) disappear. Psychother Res. 2006;16(02):184–7.

Anderson T, McClintock AS, Himawan L, Song X, Patterson CL. A prospective study of therapist facilitative interpersonal skills as a predictor of treatment outcome. J Consult Clin Psychol. 2016;84:57–66.

Røed K. Active social insurance. IZA J Labor Policy. 2012;1(1):8.

Landstad BJ, Wendelborg C, Hedlund M. Factors explaining return to work for long-term sick workers in Norway. Disabil Rehabil. 2009;31(15):1215–26.

Aasdahl L, Standal MI, Hagen R, Solbjør M, Bagøien G, Fossen H, Foldal VS, Bjørngaard JH, Rysstad T, Grotle M, Johnsen R. Effectiveness of’motivational interviewing’on sick leave: a randomized controlled trial in a social insurance setting. Scand J Work Env Hea. 2023;49(7):477.

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

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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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Social Work Research Methods That Drive the Practice

Data-Driven Work

Quantitative vs. Qualitative

Quantitative Research

Qualitative Research

Mixed Methods Research

The Importance of Research Design

Research Methods in Social Work

Program Evaluations

Needs Assessments

Randomized Controlled Trials

Descriptive Studies

Single-System Designs

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SWK 327: Social Work Research Methods: Qualitative

Tyoes of Qualitative Research

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Qualitative Research: Sample Journals

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“I need to take care of myself”: a qualitative study on coping strategies, support and health promotion for social workers serving refugees and homeless individuals

Conclusions

Social work in the refugee and homeless aid

Coping strategies of social workers

Sources of support for social workers

Workplace health promotion for social workers

Theoretical framework

Study aims and research questions

Materials and methods

Recruitment of participants

Data collection

Data analysis

Participant characteristics

Coping strategies

Problem-oriented strategies

Work tasks and content

Work organisation

Social relations

Personal strategies

Emotion-oriented strategies

Engagement in leisure activities

Acceptance and focus

Self-care and mindfulness

Distance to work

Sources of support

Support from colleagues and supervisors

Team meetings

Supervision

Training courses

Support from other institutions

Support in private life

Available health promotion offers

Needs and wishes for health promotion offers

Implications

Strengths and limitations

Availability of data and materials

Acknowledgements

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Corresponding author

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Consent for publication

Competing interests

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Supplementary information

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