Emotions, thoughts and motives affecting return-to-work and employment decisions: A qualitative study covering the perspective of people with spinal cord injury and their employers

Background Although individuals who experience spinal cord injury (SCI) face significant challenges in entering and sustaining employment, there is limited evidence on how psychological factors shape their employment decisions and those of potential employers. Objective This qualitative study aimed to identify emotions, thoughts, and motives of persons who experience SCI and employers that influence their decision to return to or continue competitive employment. Methods We conducted problem-centered interviews with ten individuals who experience SCI and ten employers who had recently been involved in a vocational integration process at the Swiss Paraplegic Centre. The interviews were analyzed using thematic analysis, and the findings validated through a focus group discussion with vocational integration experts. Results Work performance and related uncertainties about what it means to work with an SCI emerged as central themes for both participant groups. In addition, persons who experience SCI emphasized the importance of their job content and interpersonal work environment, whereas employers highlighted the critical role of human resource planning and the injured employees’ work attitude. Conclusions The themes identified in this study are central to the return-to-work and employment decision-making process following the onset of an SCI. They can inform the development of guidelines for vocational integration practice, support open communication between persons with SCI and their employers, and guide awareness campaigns aimed at promoting inclusive national labor markets.