Abstract
BACKGROUND: Coronary heart disease (CHD) is increasingly affecting younger adults, but many face difficulties returning to work, exacerbating financial burdens. Although vocational rehabilitation may improve employment outcomes, evidence for Chinese CHD patients remains scarce. Therefore, the goal of this study is to improve the employment status of middle-aged and young patients with CHD by implementing vocational rehabilitation measures based on society ecosystems theory. METHODS: The vocational rehabilitation program was developed in a multi-stage process. First, a preliminary draft was formulated based on a literature review, expert panels, and semi-structured interviews. Subsequently, this draft was refined and validated through a two-round Delphi expert consensus process. Following this, a pilot study was conducted to assess its feasibility. Finally, we evaluated the finalized program in a single-center randomized controlled trial, where 158 participants were equally randomized to receive either the 3-month intervention (n = 79) or usual care (n = 79). Return-to-work rates were the primary outcome indicator, with anxiety, quality of life, and return-to-work self-efficacy as secondary outcome indicators. RESULTS: Following the 3-month intervention, the vocational rehabilitation intervention significantly improved return-to-work rates compared to the control group (87.1% vs. 61.6%; χ (2) = 12.114, p < 0.001). In addition, return-to-work self-efficacy, quality of life, and anxiety improved in the intervention group after the intervention, and the difference was statistically significant compared to the control group (all p < 0.05). After adjusting for demographic characteristics and clinically relevant factors, the logistic regression model results robustly demonstrated that patients in the intervention group had 5.204 times the odds of successfully returning to work compared to those in the control group [95% CI (2.060, 13.148), p < 0.001]. CONCLUSION: Our findings indicate that ecosystem theory-based vocational rehabilitation can effectively enhance employment outcomes in young and middle-aged patients with CHD. Healthcare professionals should consider multidimensional factors when developing return-to-work interventions, with future efforts incorporating workplace-related considerations.