From efficacy to effectiveness: Case studies in unemployment research

Centre for Health Equity Training Research and Evaluation, School of Public Health and Community Medicine, University of New South Wales, Liverpool BC 1871, Australia.
Journal of Public Health (Impact Factor: 2.04). 10/2004; 26(3):297-302. DOI: 10.1093/pubmed/fdh146
Source: PubMed


There have been few attempts to implement and disseminate programmes to address the psychological health impact of unemployment despite the burden of this problem upon public health and health services. One approach that has demonstrated efficacy in promoting both psychological health and employment for this group is based upon the principles of cognitive behavioural therapy (CBT). We have been involved in three interventions based upon CBT to improve the psychological health of people who are unemployed, delivered through existing service structures in Australia: employment support agencies, general practice and mental health services. In this paper, we examine our experiences in conducting research within these service organizations using a framework for collaboration between researchers and services based upon intersectoral action. While effective collaboration can facilitate the implementation of research within systems, poor collaboration can impact upon the integrity of research designs. In our experience, it was the capacity of service organizations to address the psychological health impact of unemployment in particular that had a significant effect upon adoption of the intervention. Service organizations did not have structures to support the rigorous evaluation of interventions nor did they have funding arrangements that facilitated effective collaboration on research to address psychological issues. The dissemination of evidence-based interventions like CBT to populations of people who are unemployed in Australia is hindered by the absence of an accessible and appropriate system through which to address the psychological health impact of unemployment.

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Available from: Elizabeth Harris, Dec 27, 2013
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    • "Typically these programs include assessment, provision of appropriate interventions, work modification, work preparation, return to work strategies and ongoing amelioration of work-related problems (Chamberlain , 2007). Some programs mainly involve social service agencies with health services supplying intermittent support (Creed, 1998; Harris & Harris, 2009) whereas in others, social service and health professionals intentionally work together as a team (Department for Work & Pensions, 2006; Rose & Harris, 2004). "
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    ABSTRACT: Providing Access to Health Solutions (PATHS) is a New Zealand primary care based interdisciplinary, intersectoral vocational rehabilitation program working with clients who are unemployed and have health challenges inhibiting employment. This study examined the contribution of the nurse working in the PATHS program. A case study approach included in-depth interviews of PATHs program clients, stakeholders, and a documentation review. Five themes emerged from the triangulated data: assessment and planning, personal and systems advocacy, persevering to the goal, the nursing approach, and respecting timing. Program stakeholders valued the nurse's role in client assessment, risk analysis, ongoing client monitoring, and client coaching. Clients valued the nurse's work in supporting health literacy, joint health planning, advocating for timely provision of health and lifestyle behavior services as well as supporting, coaching, and prompting. These roles together with those of other PATHS team members have led to many clients successfully entering or re-entering employment.
    Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 07/2012; 37(4):185-94. DOI:10.1002/rnj.31 · 1.15 Impact Factor
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    • "Cognitive-behavioural therapy may be needed to target specific pain-related beliefs and coping strategies for modification.[16] Rose and Harris [17] have identified cognitive behavioural therapy as a promising intervention to improve the psychological health of persons who are unemployed. Recently, Watson and colleagues [18] have provided some indications that a combined physical exercise and cognitive behavioural programme improved physical fitness as well as increased employment rates among unemployed participants with health complaints. "
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    ABSTRACT: Employment status is an important determinant of health inequalities. Among unemployed people, poor health decreases the likelihood of re-employment. A randomised controlled trial with 6 months' follow-up among unemployed people with health complaints receiving social security benefits from the city of Rotterdam, The Netherlands. In total, 456 people were assigned to the control group and 465 people to the intervention group. The intervention consisted of three sessions weekly over 12 weeks. One session a week was focused on education to enhance the ability to cope with (health) problems, and two weekly sessions consisted of physical activities. The primary outcome measures were perceived health, measured by the Short Form 36 Health Survey, and psychological measures mastery, self-esteem and pain-related fear of movement. Secondary outcome measures were work values, job search activities and re-employment. Enrolment in the intervention programme was 65%, and 72% completed the programme with over 70% attendance at all sessions. The intervention had a good reach among subjects with lower education, but had no effect on mental and physical health, mastery, self-esteem and pain-related fear of movement. Participation in the programme had no influence on work values, job search activities or re-employment. This intervention programme aimed at the promotion of physical and mental health in unemployed people with health complaints did not show beneficial effects. The lack of integration into regular vocational rehabilitation activities may have interfered with these findings. This particular health programme cannot be recommended for implementation.
    Journal of epidemiology and community health 08/2009; 63(11):893-9. DOI:10.1136/jech.2008.080432 · 3.50 Impact Factor
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