An exploration of employment factors in working-age people with chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is a debilitating lung condition causing distressing symptoms. People with COPD experience variability of symptoms and have a greater number of comorbidities and lower quality of life than people with other long-term conditions. COPD is typically diagnosed from the age of 40, at a time where individuals are working to have a stable income and might be saving towards retirement. Employment is important for generating an income, social stimulation, a sense of purpose, use of skill and routine. Research suggests that people with COPD exit the workforce early and have a reduced income through having to work part-time or not work at all. A narrative literature review was conducted and highlights that the research on the impact of COPD on employment is weak and conflicting making the role of COPD on absenteeism, presenteeism, early retirement, income and career difficult to determine. This lack of clarity is due to the deficiency in use of standardised and validated tools to measure these concepts in different organisations, contexts and countries. In addition, only grey literature considers the employment experiences of people with COPD indicating a dearth of publications to date. This body of work further addresses that gap to enhance our understanding of COPD and employment and to inform the development of recommendations to support people with COPD. The aim was to explore employment in working-age people with COPD to investigate factors influencing employment and understand experiences of sustaining or leaving employment. Through a pragmatic worldview, this research adopted a mixed-methods approach to address the thesis aims and objectives. Two studies were conducted: a mixed-methods study and a qualitative study. Study 1 comprised of two components: a quantitative cross-sectional survey and qualitative interviews. A health and well-being questionnaire consisting of a selection of validated and non-validated instruments was developed. The questionnaire incorporated the COPD Assessment Test (CAT), Quality of Life (EQ-5D-5L), Satisfaction with Life (SWLS), Warwick-Edinburgh Mental Well-being Scale (WEMWBS), The Hospital Anxiety Depression Scale (HADS), The Connor-Davidson resilience Scale (CD-RISC), The Work Productivity and Activity Impairment Questionnaire (WPAIG:GH), and The Stanford Presenteeism Scale (SPS-6), and a non-validated Workplace Control and Adaptation measure. The questionnaire was administered to 14 people with COPD who were either employed, or no longer employed because of their COPD. This questionnaire was administered in a private office and responses were captured in a paper-based format. Data were analysed descriptively. A sub-sample of four individuals completed face-to-face semi-structured interviews to explore their employment experiences. Interviews were conducted in a place of the participants choosing (office/home), digitally recorded and transcribed. The qualitative data were analysed using the Framework method. Study 2 was a qualitative study of 17 in-depth, one-to-one semi-structured interviews exploring the barriers, facilitators, and support aspects of employment in people with COPD was conducted. Interviews took part in participants homes. An interview schedule with prompt questions developed from Study 1 interviews and responses was used to guide the interviews. Interviews were recorded and transcribed, and data analysed using the Framework method. The research methodology was guided by the principles of interpretive description and the theoretical perspective of resilience was considered throughout the study. Study 1 demonstrated that it was possible to recruit participants with COPD to collect both quantitative data on psychosocial and physical factors influencing employment and the impact of COPD on employment, and qualitative data on employment experiences. The procedures implemented and documentation designed for this study were appropriate and no modifications were required. A future study could be scaled up with some modification to the content of the questionnaire and the recruitment process dependent on the adopted study design and further resources. The questionnaire used was effective in collecting the necessary data and the results illustrated broad trends. The CAT scores of people in employment were lower overall than those not employed. For employed participants, quality of life scores, perceptions of health, satisfaction with life, mental well-being, and mental health through HADS scores were higher than those not employed. Resilience was another construct where employed participants demonstrated greater resiliency than those not employed. The work productivity, presenteeism and workplace control and adaptation measures also provided data on the employed participants work activity and participants had low absenteeism and presenteeism and workplace flexibility. Three higher order classifications of health and COPD in the workplace, employment support for COPD and The bigger picture of COPD and employment were developed. Participants experienced variability in their COPD symptoms and wellbeing at work and adopt personal and workplace strategies to manage the challenges were developed from the qualitative data. Participants were not always clear about their legal rights and what to expect from their employer or know where to access support. Further, people with COPD value their work for structure and routine and an early, unplanned exit from the workplace could be challenging for some. The findings indicated what was important for the participants in relation to their employment and related challenges in working with COPD. This realisation influenced the decision by the researcher to focus solely on developing a deeper understanding of the employment experiences of people with COPD. Following discussion with the PhD supervisory team the decision to proceed with a qualitative study to provide a more robust foundation for the survey was agreed and implemented in the subsequent qualitative study. Study 2 highlighted a willingness of people with COPD to engage in research exploring employment experiences. People with COPD want to continue working as long as possible and many are supported by their employers to do so; however, others might encounter pressure to leave their employment from their colleagues or employer. Personal finances can be a considerable concern. Managers and colleagues are more empathetic if they know about COPD or have experience of similar issues. Successfully implementing actions and strategies to self-manage COPD in the workplace requires resiliency skills and employer understanding and flexibility; physical and psychological job demands may cause workplace fatigue and exhaustion. Expressing workplace needs by informing management of health status can lead to improved employment experiences. This research has contributed to the body of knowledge, illuminated some key findings and developed recommendations including: for healthcare professionals to provide more tailored support; for people with COPD to be more engaged in the communication of their needs; for employers to develop their understanding of their employees with COPD and how to make appropriate workplace adjustments; for research that investigates how people can make successful adaptation in the workplace; for policy and strategy to better integrate employment into healthcare planning.