WORKWELL process evaluation: insights from therapists and line managers

Abstract Objectives Many individuals diagnosed with inflammatory arthritis are of working age and experience challenges in maintaining employment. The WORKWELL vocational rehabilitation programme, delivered by occupational therapists in National Health Service rheumatology clinics, is designed to support job retention by aligning individuals’ abilities with their work demands. As part of a multicentre randomized controlled trial, this qualitative process evaluation explored therapists’ and line managers’ perspectives on the training, implementation and delivery of WORKWELL to inform its future integration and scalability. Methods A qualitative study was conducted using semi-structured interviews with 18 occupational therapists (26 interviews in total, pre- and post-trial) and 5 line managers across 17 National Health Service Trusts in England, Wales, and Scotland. Reflexive thematic analysis was applied inductively, followed by a deductive Normalization Process Theory analysis to explore intervention coherence, engagement, implementation and sustainability. Results Before the trial, work support was inconsistent, with occupational therapists providing informal advice and signposting but lacking structured vocational rehabilitation assessments. Post-trial, therapists viewed WORKWELL as a valuable, structured intervention, enhancing job retention support. Remote delivery during COVID-19 was well-received, improving accessibility. However, implementation challenges included time constraints, increased workloads and staffing shortages. Line managers had limited involvement but recognized the programme’s benefits, though concerns about long-term sustainability remained. Conclusions WORKWELL was successfully integrated into National Health Service practice, with remote delivery enhancing accessibility. Addressing workforce constraints, managerial engagement and digital integration could improve long-term feasibility and impact, ensuring sustained access to job retention support for people with inflammatory arthritis. Trial registration ClinicalTrials.gov NCT03942783; ISRCTN Registry ISRCTN61762297.