Development of the Heart Return to Work Intervention Programme (HRTWIP): a Delphi study

Abstract

Cardiovascular disease (CVD) is a leading cause of mortality in South Africa. According to results from a larger study the prevalence of CVD is increasing amongst individuals in the working age group and return to work (RTW) rates are less than 50%. In the Western Cape, South Africa, there are no programmes that focus on cardiac rehabilitation (CR) and vocational rehabilitation (VR) simultaneously. The aim of the larger study was to develop a RTW programme for individuals with CVD. This is the concluding process through which the Heart Return to Work Programme (HRTWIP) was developed in order to answer the research question related to the components required to design and develop a successful RTW programme for individuals with CVD in the Western Cape. A three-round e-Delphi survey was conducted from March 2020 to May 2020, with experts in CR and VR from South Africa, Netherlands, Ireland, Germany and Australia. Findings from the e-Delphi together with findings from previous phases of a larger study were triangulated using concept mapping. Qualitative data was analysed through content thematic analysis and descriptive statistics was used to analyse the quantitative data. Ten experts with a mean age of 45.7 years (SD 13.6), varying years of practice duration and multidisciplinary representation participated in the study. The outcome of the e-Delphi study resulted in the development of the HRTWIP. The HRTWIP is a 4-phase programme consisting of an assessment phase, CR and work intervention phase, work test placement phase and the final phase resulting in full participation in the worker role. Phases are fluid and interlinked. The experts approved intervention strategies that include a multidisciplinary team (MDT), a client-centred approach, case manager facilitation and an outpatient setting once independence in activities of daily living is established. The HRTWIP aims to address the worker role resumption for individuals who survived cardiac events and improve the RTW rate. The fluidity of movement through phases of the HRTWIP accommodates individual progress and the achievement of competence in each phase. Further studies on the practicality of the HRTWIP will support the the cost-effectiveness, meaningfulness and efficacy of the HRTWIP.