Communication style: help or hindrance in facilitating return to work?

'Unless people believe they can produce desired effects by their actions, they have little incentive to act' Albert Bandura, Self-Efficacy: The Exercise of Control. Bandura's theory states that 'Perceived self-efficacy refers to beliefs in one's capabilities to organise and execute the courses of action required to produce given attainments' [1]. In the workplace setting, self-efficacy is an individu-al's belief that they can do what is needed to do the tasks of the job in hand, whatever that is, whether it is returning to work after sick leave or looking for a job. It is a useful concept that has attracted significant attention with regard to unemployed people [2] but its application to return from sick leave has been little researched. It is known that the longer people who have chronic health problems are absent from work, the less likely they are to return. This is particularly well described for conditions such as low back pain [3]. Recent research has also found that self-efficacy is significantly lower among those with sickness absence compared to the general working population [4]. The authors conclude that lower self-efficacy among those off sick is a result of the sickness absence rather than a precursor to it. If being absent from work lowers self-efficacy and low self-efficacy is linked to inactivity and inability to take positive steps to return to work, occupational physicians should avoid lowering individual self-efficacy through the use of inappropriate language. It can be argued that to speak to an individual of having 'barriers' and overcoming their 'barriers' may be detrimental to that individual and impair their chances of a successful return to work. There are different conceptualizations of disability or the 'disablement process' [5] including the medical and biopsychosocial models and the 'interaction' approach of the recently adopted UN Convention of Disability [6]. There is also the 'social' model, described by Oliver in 1996 [7] which describes how it is society or more specifically the environment (including attitudes, organization , communication and other factors) which disables people with impairment by creating barriers to full social and economic participation. These result in disabled people being unable to move, function and communicate as effectively as people without impairments. As a great deal of the environment we live in is designed consciously or unconsciously by non-impaired people, for non-impaired living, disabled people are thus prevented from full participation. Discussion of this issue has resulted in …