Seminar Presentation 4-3

4-3 (Presentation within Topical Seminar 4):
What leads to the expectation to return to work? Insights from a social-cognitive decision making model of future work behaviour.

Presented by: Debra A Dunstan

Seminar Details

Part of Topical Seminar 4: Psychosocial Factors Involved in the RTW Process
Tuesday September 30


Dunstan DA1, Meade Covic T1, Tyson GA1

  1. School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale
  2. School of Psychology, University of Western Sydney, Sydney
  3. School of Psychology, Charles Sturt University, Bathurst, AUSTRALIA



The Theory of Planned Behaviour (TPB) is a social-cognitive decision making model that suggests an individual’s intention or expectation to perform a behaviour is the immediate precursor of that behaviour and results from the combined effect of three independent influences. These are: Attitude (the net outcome of positive and negative appraisals of the act); Subject Norm (the net social pressure from important others); and, Perceived Behavioural Control (the degree of challenge associated with performing the behaviour). The aim of this study was to use a TPB model of return-to-work (RTW) behaviour to identify the antecedents of future work expectations in employees with a compensable musculoskeletal condition.


Standardised procedures were used to construct a TPB model and associated questionnaire to measure the target behaviour “working or continuing to work in three months time”. Participants were Australian injured workers (N = 174), mean age = 43.7 years, mean time since last worked = 9.94 months, mean pain severity (0-10) = 5.86, 53.2% male, 48.1% back injury, 34.2% unskilled. A pilot group (n = 16), plus 3 experts, served as the developmental sample to generate items for the direct and indirect (belief-based) measures of the model’s components. A validation sample (n = 158) completed the questionnaire.


The model met standard psychometric requirements. Attitude, Subjective Norm and Perceived Behavioural Control explained 76% of the variance in the intention or expectation to be working in three months time (R2 = .76, p < .001). The influencing beliefs with the highest associated factor loadings per component were: for ‘Attitude’ (from 8 advantages or disadvantages of working) – increased pain (r = .85); fear of re-injury (r = .85); social contact (r = .85); and, gaining respect and acceptance (r = .84); ‘Subjective Norm’ (from 6 referents) - the opinion of co-workers (r = .80), friends (r = .80) and treating doctor (r = .79); and ‘Perceived Behavioural Control’ (from 9 inhibitors or facilitators of working) – restricted physical capacity (r = .84), pain (r =.80), co-worker support (r = .88) and employer support (r = .86).


This study demonstrated that the TPB is a viable theoretical framework for conceptualizing and understanding the factors influencing the future work expectations of injured employees. The results suggest a range of biopsychosocial issues combine to produce expectations, the strongest influences being: social aspects of work, communication from the treating doctor, co-worker support and pain-related disability.