Constructing therapeutic support and negotiating competing agendas: A discourse analysis of vocational advice provided to individuals who are absent from work due to ill-health

Saunders, Benjamin; Chew-Graham, Carolyn; Sowden, Gail; Cooke, Kendra; Walker-Bone, Karen; Madan, Ira; Parsons, Vaughan; Linaker, Cathy H; Wynne-Jones, Gwenllian

Abstract

Work participation is known to benefit people’s overall health and wellbeing, but accessing vocational support during periods of sickness absence to facilitate return-to-work can be challenging for many people. In this study, we explored how vocational advice was delivered by trained vocational support workers (VSWs) to people who had been signed-off from work by their General Practitioner (GP), as part of a feasibility study testing a vocational advice intervention. We investigated the discursive and interactional strategies employed by VSWs and people absent from work, to pursue their joint and respective goals. Theme-oriented discourse analysis was carried out on eight VSW consultations. These consultations were shown to be complex interactions, during which VSWs utilised a range of strategies to provide therapeutic support in discussions about work. These included; signalling empathy with the person’s perspective; positively evaluating their personal qualities and prior actions; reflecting individuals’ views back to them to show they had been heard and understood; fostering a collaborative approach to action-planning; and attempting to reassure individuals about their return-to-work concerns. Some individuals were reluctant to engage in return-to-work planning, resulting in back-and-forth interactional negotiations between theirs and the VSW’s individual goals and agendas. This led to VSWs putting in considerable interactional ‘work’ to subtly shift the discussion towards return-to-work planning. The discursive strategies we have identified have implications for training health professionals to facilitate work-orientated conversations with their patients, and will also inform training provided to VSWs ahead of a randomised controlled trial.

Citation

Saunders, B., Chew-Graham, C., Sowden, G., Cooke, K., Walker-Bone, K., Madan, I., Parsons, V., Linaker, C. H., & Wynne-Jones, G. (2023). Constructing therapeutic support and negotiating competing agendas: A discourse analysis of vocational advice provided to individuals who are absent from work due to ill-health. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 28(2), 185-202. https://doi.org/10.1177/13634593221148446

• Journal Article Type: Article
• Acceptance Date: Apr 24, 2023
• Online Publication Date: Apr 24, 2023
• Publication Date: Apr 24, 2023
• Journal: Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine
• Print ISSN: 1363-4593
• Electronic ISSN: 1461-7196
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 28
• Issue: 2
• Pages: 185-202
• DOI: https://doi.org/10.1177/13634593221148446
• Keywords: theme-oriented discourse analysistherapeutic supportwork absence
• Public URL: https://keele-repository.worktribe.com/output/426940
• Publisher URL: https://journals.sagepub.com/doi/10.1177/13634593221148446