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These findings, however, differ from previous critical reviews of scale development practices, which found that most of the reported studies used exclusively deductive methods Hinkin ; Kapuscinski and Masters ; Ladhari This is particularly important since the quality of generated items depends on the way that the construct is defined.
Failing to adequately define the conceptual domain of a construct causes several problems related to poor construct definition, leading to, for example, a confusion about what the construct does and does not refer to, including the similarities and differences between it and other constructs that already exist in the field, b indicators that may either be deficient or contaminated, and c invalid conclusions about relationships with other constructs MacKenzie et al.
Considering that item generation may be the most important part of the scale development process, future measures should be developed using the appropriate definition of the conceptual domain based on the combination of both deductive and inductive approaches.
Our results suggest that literature review was the most widely used deductive method e. This is consistent with the views of several other researchers who have systematically reviewed scales Bastos et al.
Nevertheless, this finding differs from another study Kapuscinski and Masters that found that the most common deductive strategies were reading works by spiritual leaders, theory written by psychologists, and discussion among authors. Literature review should be considered central for the enumeration of the constructs.
It also serves to clarify the nature and variety of the target construct content. In addition, literature reviews help to identify existing measures that can be used as references to create new scales Clark and Watson ; DeVellis In this sense, future research should consider the literature review as the initial and necessary deductive step foundational to building a new scale.
This review also highlights the fact that interviews and focus groups were the most widely used inductive methods e. Similar results were found in the systematic review by Kapuscinski and Masters , Sveinbjornsdottir and Thorsteinsson , and Ladhari These findings have particular relevance to future researchers, since they emphasize the importance of using methodological strategies that consider the opinions of the target population.
Related to step 2, theoretical analysis, the results of this review indicate that expert judges have been the most widely utilized tool for analyzing content validity e. Previous studies have also found expert opinion to be the most common qualitative method for the elimination of unsuitable items Kapuscinski and Masters ; Ladhari In the literature review conducted by Hardesty and Bearden , the authors highlighted the importance of these experts to carefully analyze the initial item pool.
They suggested that any research using new, changed, or previously unexamined scale items, should at a minimum be judged by a panel of experts. However, the authors also point out the apparent lack of consistency in the literature in terms of how researchers use the opinions of expert judges in aiding the decision of whether or not to retain items for a scale.
Given this inconsistency, the authors developed guidelines regarding the application of different decision rules to use for item retention. Future research in developing scales should be concerned, not only with opinions from experts but also with the opinions of the target population.
In addition, a smaller minority combined the two approaches in the assessment of item content e. The limited use of target population opinions is a problem.
A previous study of systematic scale development reviews found that the opinion of these people is the basis for content validity Bastos et al. As highlighted by Clark and Watson and Malhotra , it is essential for the new scale to undergo prior review by members of the target population. Another problem noted in this systematic review was that some studies failed to clearly report how they performed the theoretical analysis of the items e.
We hypothesized that the authors either did not perform this analysis or found it unimportant to record. Future research should consider this analysis, as well as all subsequent analyses, necessary and relevant for reporting. Almost all studies This question seems to have been almost overcome in recent studies, since the vast majority of the analyzed studies used the factor analysis method.
Among the studies than used factor analysis, the majority chose to use EFA e.
Similar to our findings, Bastos et al. EFA has extensive value because it is considered to be effective in identifying the underlying latent variables or factors of a measure by exploring relationships among observed variables.
However, it allows for more subjectivity in the decision-making process than many other statistical procedures, which can be considered a problem Roberson et al. For more consistent results on the psychometric indices of the new scale, DeVellis indicates the combined use of EFA and CFA, as was performed with most studies evaluated in this review.
In CFA, the specific hypothesized factor structure proposed in EFA including the correlations among the factors is statistically evaluated. If the estimated model fits the data, then a researcher concludes that the factor structure replicates. If not, the modification indices are used to identify where constraints placed on the factor pattern are causing a misfit Reise et al. Research of employer practices and their impact on health and disability may be improved by adopting a life-course perspective on employee health and disability.
This perspective creates an opportunity to examine how the impact of workplace factors and workplace responses to work disability might differ depending on the age and career stage of a worker, and where particular workplace WDP approaches may be more important.
Although some work disability problems observed in aging workers are primarily related to health, other factors—such as competing retirement options, career status, likelihood of accommodations and mobility in the workforce—are specific to age group and career stage, and can interact with health [ 3 ].
Economic, social and demographic changes have led to an increased need to include more older workers in the workforce, and to find ways to better enable workers with health conditions to maintain employment [ 4 ]. This direction is supported by new legislation that seeks to support the rights and ability to work of persons with potentially disabling conditions, as exemplified by the UN Convention of the Rights of Persons with Disabilities CRPD , stating that workers with disabilities have an equal opportunity to employment [ 5 ].
The rights of disabled people set out in the CRPD presently are recognized by more than one hundred and fifty nations who ratified the treaty [ 5 ]. These developments all suggest the need for more information on how workplace factors and related interventions can better support the employment of persons with various health conditions, across the life-course.
There are fundamental principles and effective strategies for work disability prevention WDP that appear to be common across health conditions and work situations, and are consistent with the goals of the CRPD. However, most research on workplace issues and WDP has focused on musculoskeletal disorders and work injuries, there is less evidence for generalization of these principles across other types of health conditions [ 7 ].
Our objective was to identify relevant scientific research and current employer practices for managing chronic health conditions and related work disability in the workplace, as a basis for recommendations for improving future research of employer disability prevention strategies.
Methods and general proceedings of the conference are described in the introductory article to this special issue [ 8 ]. The authors of this article represented a sub-group tasked with understanding the state of the science with respect to employer practices for managing the increasing prevalence of chronic health conditions and workplace efforts to prevent this source of disability through job accommodation and support, through a life-course view of employment and disability.
We contrast key conceptual and theoretical frameworks, review the applicable scientific literature, assess its impact for employer decision-making, and compare recommendations with that of the employer-directed grey literature. These observations and recommendations are useful for areas that have not been thoroughly investigated.
We recommend future research priorities, based on important scientific gaps. Two chronic health conditions with divergent prevalence across the life span—mental disorders [ 9 ] and cancer [ 10 ]—were chosen as exemplars to illustrate key principles that may apply across a range of conditions. Although there are significant differences by country, retirement ages are gradually increasing in most established economies.
In older workers, chronological age may be inconsistent with career stage and status.
Some older workers may be nearing retirement, and others are already in post-retirement careers, and thus may have very different work disability considerations. Post-retirement workers may have lower job attachment, less financial or personal need to return to work after a disabling illness, and may be more interested in exploring alternative employment—especially if the job is perceived as a poor match for their capabilities.
Older workers may want to stay at work for the benefits of social engagement and discretionary income.
In many countries, employers need these workers, and are especially interested in capturing their expertise and maturity [ 13 ]. However, the growth of an aging workforce has heightened employer concerns about the ability of older workers to remain at work given their higher rate of medical illness, and increased risk for work disability [ 10 , 14 ].
Impact of Chronic Health Conditions in the Workplace Chronic health conditions—including obesity, diabetes, mental disorders, cancer, arthritis, and lung, gastrointestinal and cardiovascular diseases—account for considerable work disability WD , and reduced productivity on the job [ 15 , 16 ].
Their prevalence in the workforce is changing for several reasons. Advances in medical care is converting mortality to morbidity. Workers with chronic illness have fewer resources enabling them to retire, and the impacts of a sedentary lifestyle are becoming more manifest in older workers [ 17 ].
Many workers with chronic illness have multiple comorbidities or simultaneous conditions, challenging traditional views of a single disease as a cause of work disability, and are therefore at higher risk of frequent or prolonged work absence [ 18 ].
Several studies have examined the specific challenges that workers with chronic health conditions face at work, that place them at risk for low productivity or WD. These problems include fatigue, emotional exhaustion, inconsistent support from colleagues and supervisors, and difficulty modifying their jobs to match their capabilities [ 19 ].
With serious chronic illness, medication adherence and side-effects can be additional risk factors for lower productivity and work absence [ 20 ]. Although stigma has been primarily associated with mental illness, the problem of stigma and discrimination at work is reported across a range of chronic conditions, and interventions to educate employers and co-workers are a major emphasis of condition-specific advocacy groups for diabetes, lung disease, cancer and other conditions. Research has shown that while older workers are not at an increased risk for a work-disabling injury [ 10 , 21 ], when one does occur, older workers frequently sustain more serious injuries than younger workers, they take longer to RTW, are more likely to leave work again after attempting to RTW, and have a higher chance of never achieving a successful RTW [ 14 , 22 ] Work disability claims for older workers tend to be more costly than for younger workers [ 23 ], adding further concerns for employers.
Interventions to Promote Retention and Productivity The traditional workplace approach to address work disability and chronic illness focuses on health improvement, disease management, in systems directed by legal requirements, administrative structures, diagnostic classifications, and specific rules [ 23 ].
Despite the inverse relationship between age and positive RTW outcomes, there have been relatively few workplace interventions to improve RTW targeting older workers pre or post retirement on those with chronic illness of any age. For example, employer responses to work-related and non-work related conditions are often different, with respect to inquiry about causation, concerns about liability, case management practices, and nature of accommodations to facilitate return to work [ 25 ].
Condition-specific employment advocacy groups promote strategies to support employment of younger workers with chronic health conditions, but these lack empirical evidence of where and when they are helpful or effective. Fitness and Wellness Programs Although frequently advocated in the professional literature, general workplace fitness and lifestyle programs have limited impact on WD rates [ 23 , 26 ], even those targeting physical activity and fitness as a way of decreasing sickness-related absence [ 27 ].
These wellness programs usually fail to engage those who could most benefit, and few have documented long-term sustained health benefits in large numbers of enrollees. For example, one workplace intervention involved exercise, coaching related to vitality, and healthy eating, targeting workers over the age of 65 [ 28 ], and was not found to be cost-effective.
Another study involving female nurses age 49 or older, found that a Tai Chi workplace intervention reduced perceived work limitations compared to no intervention [ 30 ]. Medical Case Management Diagnosis—based medical case management that focuses primarily on improving clinical care and compliance, without substantial integration of workplace issues, is generally not effective in preventing work disability or improving RTW [ 31 , 32 ].
This approach fails to take into account the wide variation in work ability within a single diagnosis, and nonmedical including workplace factors that primarily determine RTW outcomes. There are a few exceptions—for example, screening and initiating treatment for an untreated, severe, and potentially-disabling condition e. Identifying Workers at Greatest Risk of Disability There are a few examples of individualized, workplace-based programs that do effectively target WD risk.
For example, Kant, Jansen et al [ 34 ] describe an intervention at a large Dutch bank, where risk for WD was identified through a screening tool, and high-risk persons were referred to an occupational physician for consultation, development of a personalized program to address workplace and individual risk factors, and follow-up.
About half of the participants had a chronic illness cardiovascular, musculoskeletal, and other conditions , although results were not reported for this group separately. An intervention that addressed lifestyle and work in a comprehensive, individualized manner, involving the workplace, for persons with diabetes and obesity, had a significant impact on lost work days in a randomized trial [ 35 ].