Minerva gastroenterology · 2026
Influencing factors of health-related productivity loss among patients with inflammatory bowel disease in paid employment based on the theory of social ecosystem: a mixed-methods study.
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Shang Liyun, Yin Rulan, Mao Lifen, Zhen Qiao, Xie Chen, Gu Jie, Shi Xiaoqing
Аннотация
BACKGROUND: Inflammatory bowel disease (IBD) often impairs work productivity, yet its multilevel determinants remain underexplored. This study aimed to assess the factors associated with paid employment-related health-related productivity loss among patients with IBD based on social ecosystem theory.
METHODS: A mixed-methods design with a nested qualitative phase was employed. The quantitative phase involved a survey of 291 patients with IBD in paid employment who were recruited from the inpatient department of a single tertiary hospital in Suzhou, China, assessing variables such as self-efficacy, fatigue, psychological status, and social support. Logistic regression analyses were used to identify factors associated with overall productivity loss and to further assess the stability of the findings. In the qualitative phase, guided by the theory of social ecosystem, semi-structured interviews were conducted with a purposively selected nested subsample to further explore the influences at the micro-, meso-, and macro-system levels.
RESULTS: The overall productivity loss rate among patients with IBD in paid employment was 67.7%, with 197 of 291 participants classified as having overall productivity loss. Factors associated with higher odds of productivity loss included female sex, older age, higher disease activity, intestinal stricture, fatigue, anxiety, depression, and business or service occupations. Protective factors were ulcerative colitis (UC), higher self-efficacy, and greater social support. Additional analysis showed that the main results remained stable after model refinement. The qualitative analysis yielded three main themes, and the percent agreement between the two coders was 92.9%.
CONCLUSIONS: Among a single-center hospital-based inpatient sample of patients with IBD in paid employment, productivity loss was common and was influenced by factors across the micro level, meso level, and macro level. These findings may support multilevel strategies to enhance self-management and psychological well-being, strengthen family and workplace support, and improve structural societal support. However, the findings should not be overgeneralized to all patients with IBD in China or to unpaid productivity domains such as domestic work and caregiving.
METHODS: A mixed-methods design with a nested qualitative phase was employed. The quantitative phase involved a survey of 291 patients with IBD in paid employment who were recruited from the inpatient department of a single tertiary hospital in Suzhou, China, assessing variables such as self-efficacy, fatigue, psychological status, and social support. Logistic regression analyses were used to identify factors associated with overall productivity loss and to further assess the stability of the findings. In the qualitative phase, guided by the theory of social ecosystem, semi-structured interviews were conducted with a purposively selected nested subsample to further explore the influences at the micro-, meso-, and macro-system levels.
RESULTS: The overall productivity loss rate among patients with IBD in paid employment was 67.7%, with 197 of 291 participants classified as having overall productivity loss. Factors associated with higher odds of productivity loss included female sex, older age, higher disease activity, intestinal stricture, fatigue, anxiety, depression, and business or service occupations. Protective factors were ulcerative colitis (UC), higher self-efficacy, and greater social support. Additional analysis showed that the main results remained stable after model refinement. The qualitative analysis yielded three main themes, and the percent agreement between the two coders was 92.9%.
CONCLUSIONS: Among a single-center hospital-based inpatient sample of patients with IBD in paid employment, productivity loss was common and was influenced by factors across the micro level, meso level, and macro level. These findings may support multilevel strategies to enhance self-management and psychological well-being, strengthen family and workplace support, and improve structural societal support. However, the findings should not be overgeneralized to all patients with IBD in China or to unpaid productivity domains such as domestic work and caregiving.