A qualitative study exploring how vocational rehabilitation for people with multiple sclerosis can be integrated within existing healthcare services in the United Kingdom

Abstract

Introduction: The employment rate of people with multiple sclerosis (MS) in the United Kingdom (UK) is around 41% compared to 81% in people without disabilities. People with MS could benefit from vocational rehabilitation (VR) services to help them manage their symptoms at work and accommodate the impact of MS on their roles and working environment. However, there is a lack of specialist VR in the UK, and it is estimated that current services only meet the needs of 10% of the population with longterm neurological conditions. Objectives/Aims: To explore how a job retention VR intervention previously developed and tested in a community setting could be implemented within existing healthcare services for people with MS in the UK National Health Service (NHS). Method(s): We sought information regarding (1) stakeholder's VR preferences and how it could work within the NHS, (2) "Usual care" for people with MS in the NHS, (3) barriers and enablers to delivering the intervention within the NHS, and (4) intervention outcomes. Data from 37 semi-structured interviews with 22 people with MS, eight employers, and seven healthcare professionals were analysed using a framework method informed by the Consolidated Framework for Implementation Research (CIFR) and the intervention logic model. Result(s): We identified four themes relating to the intervention characteristics (e.g., individually tailored content, employer engagement), structure and resources available within the healthcare system (e.g., staff levels and skills to deliver the VR intervention), needs and beliefs of the person with MS (e.g., acceptance of MS diagnosis), and VR outcomes for relevant stakeholders such as the person with MS (e.g., improved well-being, economic independence), employers (e.g., improved ability to retain diverse workforce) and society (e.g., reduced number of people on welfare benefits). Conclusion(s): Participants perceived the NHS as a trustworthy organisation with a highly skilled workforce suited to delivering VR. However, participants suggested involving other organisations such as national charities in intervention delivery to overcome NHS barriers such as staff shortages and long waiting lists.