The present study derives from a population-based and cross-sectional questionnaire survey conducted among randomly selected long-term sickness absentees (n=10 042) who in 2003 had an ongoing sick-leave spell that had lasted for 6–8 months. There were 5802 respondents to the survey which was conducted in 2004; the results of other aspects of the survey have been previously reported.6–8
In the present study we have examined the respondents' experiences using a questionnaire asking about positive and negative encounters, what kinds of encounters they had experienced and how they reacted in terms of feeling respected or wronged. The response options were ‘yes’ and ‘no’ to the questions whether or not they had experiences of positive and negative encounters in healthcare. To the questions asking how the participants felt when experiencing positive and negative encounters, there were several response options, such as: ‘I felt respected/wronged’, ‘I was happy/disappointed’, ‘I felt satisfied/became angry’, etc. The participants were asked whether or not they completely agreed/disagreed or largely agreed/disagreed with the option. When the results were analysed, those who completely or largely agreed were collapsed into one group (agree) as were those who completely or largely disagreed (do not agree).
The patients were also asked to estimate how these encounters had affected their ability to return to work, in terms of being impeded, not being influenced or being facilitated. Response options were not being influenced, being impeded, being facilitated very much or being facilitated to a certain extent. When results were analysed, the response options were collapsed into those who were impeded and those who were facilitated. In addition, the respondents were asked if they were sick-listed for (a) psychiatric disorders, (b) musculoskeletal pain, (c) other somatic diseases or (d) more than one of the previous categories. When presenting the results, we focus on respondents in categories a–c.
The results are presented as proportions (with 95% CIs) of those who estimated that return to work was facilitated compared to those who stated that return to work was not influenced or impeded when experiencing positive encounters/feeling respected, and of those who felt impeded compared to those who stated that return to work was not influenced or facilitated when experiencing negative encounters/feeling wronged. Focusing on the association between respectful/unfair encounters and return to work, we performed logistic regression analysis adjusting for different background variables such as sex, age, educational level and different diagnoses. However, adjustment made no substantial difference to the results. Accordingly, we present the crude proportions with 95% CIs.
The frequency and associations between positive encounters and feeling respected, and negative encounters and feeling wronged, are presented as attributable risks (AR)9
with a 95% CI, using the R-package pARtial.10
Since a majority of all encounters concerned physicians (70%), we have replaced the wording ‘healthcare providers including physiotherapists and midwives’ in the questionnaire with ‘physicians’ in the text.
The study was approved by the regional research ethics committee in Linköping (Dnr 03-261).