Navigating between stakeholders in return-to-work processes: A qualitative study exploring experiences of workers on sick leave due to back pain.

Background: Return-to-work processes involve many stakeholders who need to cooperate to best support the person on sick leave. Yet, there is little knowledge of how workers sick listed due to back pain experience navigating between stakeholders.

Objective: This study aimed to explore how Danish workers on sick leave due to back pain experience navigating between the involved stakeholders, focusing on settings related to social work, health care and workplace.

Methods: Sixteen individual semi-structured interviews were conducted and data analysed using a thematic analysis approach.

Results: Analysis resulted in three themes. 1) 'Meeting the system' where establishing a positive relationship with the social worker was hampered by a negative perception of the job centre. This perception was initiated by the convening letter and accentuated by physical meetings being experienced as a waste of time. 2) In 'Navigating between systems' some participants lacked support from professionals to navigate the role as messenger between the job centre and health care system. 3) In 'The workplace-a familiar arena' workers experience the workplace as a familiar arena, even if negative decisions were made. Analysis additionally revealed that patients' return-to-work processes could be divided into two types, namely complex and smooth.

Conclusion: The initial contact from the job centre seems pivotal for the following return-to-work process. The main challenges experienced by sick listed workers were related to the job centre and to being a messenger between job centre and health care, not to their workplace and the decisions made there.