160 Chapter 8 (France) to 42 hours (Switzerland) per week. This implies that the definition of fulltime depends on social norms, as well as legal and collective arrangements between employers and employees, and policies within companies. Moreover, Dutch professionals and patient representatives stated that it is impossible to prescribe a universal maximum of working hours, as the ability to work fulltime may be influenced by the context: i.e., workers’ social situations can positively (resources) and negatively (additional roles/tasks, stressors) affect their ability to work fulltime. These findings confirm the complexity and variable nature of the concept inability to work fulltime, which may be interpreted as: every person has his/her own maximum of hours that he/ she can work, given the current context. The findings also stress that the assessment of inability to work fulltime should be considered from a more holistic, biopsychosocial view, taking into account the influence of personal- and environmental factors. Although we have not investigated the normative aspect, we have provided insight into the different factors associated with inability to work fulltime. In Chapters 4 to 6 we further explored associations of age, gender, educational level, and multimorbidity with inability to work fulltime, as explorative studies had mentioned these as potential dimensions of the issue (Chapters 2 and 3). Although findings in the studies using register data suggested that higher age, female gender, higher education and multimorbidity were in the total sample associated with being assessed as unable to work fulltime, it was interesting to see that these associations were not consistent; they differed between and within diagnosis groups (for cancer and mental disorders; see Chapters 5 and 6). Furthermore, with regard to being employed we found no discrimination for age, gender and educational level, as none of these variables significantly moderated the association of inability to work fulltime with having paid employment a year later (Chapter 7). An additional finding was that the prevalence of inability to work fulltime varied greatly among different disease groups (Chapter 4), as well as within diagnosis groups (cancer and mental disorders, Chapters 5 and 6). This may indicate that when assessing inability to work fulltime, the physician takes into account the diagnosis and its impact on someone’s functioning. Perhaps this has to do with the relationship between diagnosis of a disease itself, and debilitating symptoms related to it, such as energy deficit and cognitive impairment. In the different studies using register data, we found that especially applicants with diagnoses associated with symptoms of energy loss (i.e., blood-related diseases, respiratory diseases and specific mental disorders like mood affective disorders and schizophrenia) had higher risk of being unable to work fulltime. Energy loss may affect capacities like endurance, making it more difficult for these workers to work 8 hours a day and/or 5 days a week. Our qualitative interview study (Chapter 2), indicated fatigue, cognitive
RkJQdWJsaXNoZXIy MTk4NDMw