22 Chapter 2 describing its dimensions and translating these into measurable indicators [8]. Effective conceptualizing and operationalization of the concept inability to work fulltime will thus shed light on its key elements and measurable indicators. This insight can then be used to develop methods for its assessment. This study seeks insight regarding conceptualization and operationalization of the concept of inability to work fulltime, based, among other things, on the perspectives of both patients and physicians. To assess the concept effectively, we also want to explore its dimensions and indicators. Our specific research questions are: 1) What are the key elements (characteristics and dimensions) of inability to work fulltime?; 2) What are measurable indicators of inability to work fulltime?; and 3) Which methods can be used to assess the measurable indicators of inability to work fulltime? METHODS Study design For our study, we used qualitative interviews to explore the concept of inability to work fulltime. Qualitative research is useful for understanding complex issues, explaining people’s beliefs and behaviours, and identifying social or cultural norms [9]. To evaluate the collected data we used thematic analysis, applying elements of both phenomenology and the grounded theory approach to content analysis to conceptualize and operationalize the concept. Dutch law required no ethical approval for this study, as participants were not subject to any intervention. All participants provided informed consent to record the interviews and publish the results, given that data were anonymized and untraceable to individuals. Participation in the study was voluntary, and participants received no incentive for participation. Participants We explored the concept inability to work fulltime from the perspectives of both the patient and the physician in order to triangulate points of view from these two main stakeholders. We invited physicians in staff and/or management positions in insurance and occupational medicine and in both public and private disability insurance, preferably with practical experience and with adequate knowledge of work disability assessment at scientific or staff levels. For the patients’ perspective, we invited representatives, expert staff members of patient organizations in the Netherlands, to participate. Patient organizations provide information, offer fellow sufferers contact, promote interests, organize activities, and support groups of specific patients not only with healthcare issues but also regarding social and employment participation. A patient organization is often established for and by patients. We purposively sampled patient representatives to include the major disease groups related to work disability
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