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Stakeholder Perspectives on Implementing the Pain-at-Work Toolkit: A Qualitative Study Using Normalisation Process Theory
ABSTRACT
Background:
Chronic pain affects a substantial proportion of the UK workforce, with significant consequences for employees, employers, and the wider economy. Despite recommendations supporting self-management approaches, workplace resources for employees living with chronic pain remain limited. The Pain-at-Work Toolkit is a web-based digital intervention developed through participatory research to support employees in managing chronic pain at work. A recent feasibility study found the Toolkit to be accessible, relevant, and acceptable to users, and associated with positive self-management actions. Understanding factors that may influence its implementation in workplace settings is a critical next step.
Objective:
To explore stakeholders' perspectives on implementing the Pain-at-Work Toolkit in workplace settings and identify barriers and facilitators to its adoption, integration, and sustainability.
Methods:
A qualitative study was conducted using purposive sampling to recruit 41 workplace stakeholders from a range of sectors in England. Participants took part in one-off semi-structured interviews focused on the potential implementation of the Toolkit. Data were analysed using codebook thematic analysis. Themes were subsequently mapped to Normalisation Process Theory (NPT) to examine factors influencing implementation, embedding, and long-term use.
Results:
Mapping findings to NPT highlighted key implementation processes relating to coherence, engagement, operational integration, and sustainability. Three themes were identified: “Gauging the Gap”, which reflected recognition of unmet workplace support needs for employees with chronic pain; “Assessing the Fit”, which captured perceptions of the Toolkit's relevance, acceptability, and compatibility with organisational practices; and “Strategising: Consideration of the Core Ingredients”, which described stakeholder recommendations for successful implementation. Participants viewed the Toolkit as addressing an important gap in workplace health support. Key facilitators included leadership advocacy, workplace champions, targeted communication strategies, and integration of the Toolkit into existing organisational systems and wellbeing initiatives. Barriers included concerns about employee disclosure, stigma, managerial engagement, and anxiety regarding monitoring or surveillance. Stakeholders proposed practical solutions to address these challenges, including implementation guidance, anti-stigma initiatives, and sharing peer success stories.
Conclusions:
Stakeholders perceived the Pain-at-Work Toolkit as a valuable and feasible resource for supporting employees living with chronic pain. Mapping findings to NPT identified factors likely to influence implementation and highlighted strategies to promote adoption, integration, and sustainability across diverse workplace settings. These findings provide an evidence-informed foundation for future implementation planning and scale-up of the Toolkit. Clinical Trial: NCT05838677
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