Medicine at work: a qualitative study into patients’ experiences with medication self-management and burden in the context of work

Abstract

Objectives

The number of people with a chronic condition in the workforce is rising and the majority use medication. Medication self-management at work might be problematic. This study aimed to provide insight into the experiences of employees with balancing medication self-management and work.

Methods

Semi-structured interviews were held with 18 individuals with a variety of chronic health conditions, occupations, and medications. Interviews were guided by a topic list, transcribed, and open-coded. Thematic analysis identified determinants and behaviors that play a role in the interaction between medication self-management and performance and well-being at work.

Results

Fifteen participants used medication at work, mostly as needed and often administered on the go or covertly. Medication use at work was often perceived as doable due to flexibility and already established routines. However, a cumulative complexity of integrating medication use into the workday, the degree of side effects, and people’s attitude towards openness could hinder successful integration of medication self-management at work. Participants adapted their medication schedule, made adjustments during their workday, and/or found ways to cope with these challenges emotionally. Medication often enabled work participation, although side effects of medication could impact workability, and (anticipated) stigma could affect the extent to which people can be themselves at work.

Conclusions

Medication self-management at work requires adaptability from individuals themselves, their colleagues, and employers. Fostering a culture of acceptance and understanding at work while providing practical support can enhance medication self-management practices and well-being at work.

Key Points

What is already known on this topic  

• Self-management tasks, such as managing medication, can be challenging. There are indications that work might play a role in these challenges.

• In-depth and comprehensive insight into perspectives of people with a chronic condition on combining work with self-managing medication can enhance understanding and inform efforts to provide appropriate support.

What this study adds  

• The study shows that (1) characteristics of the treatment; (2) beliefs, attitudes, and perceptions of the individual; (3) job and workplace characteristics; and (4) support from colleagues and employers all play a role in medication self-management at work. These factors affect how medication self-management manifests at work, that is, how people manage their medication intake and how they deal with side effects and the (psychosocial) impact on their workability.

How this study might affect research, practice, or policy  

• Due to the diversity in experiences and the interconnectedness of contextual factors, tailored solutions should be offered to support employees to improve medication self-management at work as well as to mitigate the effects of medication self-management on performance and psychosocial well-being at work.

• When prescribing or reviewing medication, health professionals should be aware of the potential impact of work on medication use and adherence.

• The study lays a valuable foundation for further research into the interaction between medication use and work participation.

1. Introduction

About 25% to 35% of people in the workforce have a chronic physical health condition, and more than 50% of them consider their illness limiting for daily activities and work.^1,2 Individuals with a chronic condition are faced with a range of daily self-management tasks, such as taking medication, to maintain their health or prevent a further deterioration of their chronic illness, including during work hours.^3,4 Over 90% of people with a chronic condition use medication,⁵ the majority also at work.³ Medication self-management (MSM) encompasses a multitude of tasks, not limited to the practical aspects of medication management (eg, organizing, taking medication, and monitoring side effects), but also including the psychosocial and emotional treatment burden (eg, dealing with medication-related stigma, developing coping strategies, and handling changing social roles).^4,6-10

In this study, in line with the work of Cadel et al,⁶ we refer to medication self-management (MSM) as “all tasks and responsibilities that are involved with the day-to-day management of medication by an individual, including medical, emotional and role-management.” Medical management includes the organization and use of medication; emotional management encompasses managing feelings and emotions related to the health condition, and role management relates to the adaptation to or creation of new roles and responsibilities.

There are indications that MSM manifests at work or interferes with work life.¹¹ Stress from work and a lack of rhythm can make it more difficult to prioritize MSM,^7,12,13 and side effects can impact concentration at work.¹⁴ Support from co-workers and employers can help people to better manage their health and medication and better deal with treatment burden.^15-17 However, people can be hesitant to take medication in the presence of others, as it may draw attention to their health condition and raise their own concerns about how others perceive them.^15,18,19

Although these earlier studies provide a glimpse of individuals’ experiences with MSM, MSM in the work context is often studied as a (small) component within a broader study, missing in-depth focus. As a result, there is no consolidated overview of the contextual and personal factors that affect MSM at work. Furthermore, comprehensive insight on why, when, and how individuals with chronic conditions employ the full set of MSM tasks to navigate these factors is lacking. Therefore, this study aimed to understand how MSM manifests in the workplace; what the hindering and facilitating factors are; and what the impact of MSM on work and workability is.

2. Methods

2.1. Study design

In this qualitative study, 18 interviews with Dutch working individuals with a chronic condition who use medication were conducted between December 2023 and April 2024. This qualitative approach allows for a deeper exploration of the topic.²⁰ The Consolidated criteria for Reporting Qualitative Research (COREQ) checklist was used for reporting the study.²¹

2.2. Selection of participants

Participants had to be of working age (18-65 years); have paid employment for at least 12 hours a week; use prescribed medication at least once a week; and have a diagnosed chronic condition. Participants were drawn from the Nivel Panel Stronger Together (NPST), formerly the `National Panel of the Chronically ill and Disabled, a Dutch panel focused on the experiences of people with a chronic disease and/or a physical disability.²² Of the 374 eligible panel members, 45 were randomly selected to receive an invitation, either online or on paper. Twelve people agreed to participate. Due to an underrepresentation of females and younger people, an additional 30 individuals were purposively selected from the panel, of whom 5 agreed to participate. Finally, 1 more participant was invited based on struggles with MSM at work mentioned in preliminary, explorative questions in the NPST. Participants received a gift card.

2.3. Data collection

Interviews were conducted by 1 researcher (E.A.), either face-to-face in the participant’s home, online, or via telephone, and lasted on average 44 minutes. An interview guide was developed. Topics were informed by survey data from the NPST exploring themes concerning medication and work that are important to NPST members; a consultation with the NPST advisory board (a group of past NPST members that regularly advise); literature on MSM and medication-related treatment burden^6,8,11,23; and expertise from the researchers. Topics were: job characteristics; medication characteristics; experiences with taking medication at work; responses from colleagues; the attitude of the manager/employer; dealing with side effects at work; and the effects of medication use on work and workability. A pilot interview was conducted with an NPST advisory board member to verify formulation, relevance, and completeness.

2.4. Data analysis

The interviews were audio-recorded and transcribed verbatim. Data were imported into MaxQDA²⁴ and analyzed in 4 steps: data immersion, coding, creating categories, and identifying themes.²⁵ After independently open-coding 2 interviews, E.A. and research assistant Marike de Reuver discussed codes and emerging topics. After collaborative coding of a third interview, E.A. coded the remaining interviews. E.A. and M.V. discussed the results of the coding and the process of category creation and theme identification. With regards to identifying determinants of MSM at work, the data yielded a logical grouping of these factors in the categories “job characteristics,” “workplace culture and support,” and “characteristics related to the medication.” MSM behaviors were coded and grouped according to the 3 distinct MSM tasks: role, emotional, and medical management. A participant matrix was created, and raw data were regularly revisited in the iterative process of looking for patterns in the data and relationships between determinants of MSM and MSM behaviors.

2.5. Reflexivity

The first author (E.A.) conducted all interviews and initiated the analysis. She is a Dutch female researcher at an early career stage, with formal education in Nutrition and Health Promotion and additional training in work participation. She had no prior relationship with any participant. E.A. reflected on interview style and appropriateness of the topics with the pilot interview participant and subsequently with the third author (H.B.). After conducting interviews, E.A. regularly debriefed with one of the co-authors. Some of the authors had first-hand experience with medication use in work contexts, which may have introduced bias, but also enhanced the depth of understanding. An external research assistant assisted with coding, providing a fresh perspective.

2.6. Ethics

All data were collected and handled in accordance with the General Data Protection Act, the Netherlands Code of Conduct for Health Research, and the Netherlands Code of Conduct for Research Integrity. In accordance with Dutch legislation, approval by a medical ethics committee for conducting research in the NPST was not needed. All participants received an information letter about the study and provided written informed consent.

3. Results

3.1. Participant characteristics

Eighteen people participated (9 men, 9 women, aged 26-66), with varying occupations, health conditions, and medication regimens (see Table 1). Participants worked on average 32 hours per week (range 15-50 hours). About half of the participants had had periods of absenteeism or rehabilitation. One participant was on sick leave at the time of the interview, 1 was reintegrating, and 1 had retired 2.5 months prior to the interview.

Table 1.

Participant characteristics.

Category	Number (n = 18)
Sex
Female	9
Male	9
Age group
18-35	2
36-50	4
51-68	12
Occupation (by sector)
Finance and business	4
Health care	4
Manufacturing, engineering, and logistics	3
Food and hospitality	2
Social and public services	2
Facility services	1
Retail	1
Training and education	1
Employment
Business owner	3
Self-employed	1
Employee	14
Work characteristics
Evening or weekend shifts	4
Work at locations outside the main office	5
Self-reported chronic conditions (multiple possible)
Asthma/COPD	9
Cardiovascular	6
Neurological	3
Diabetes mellitus	2
Musculoskeletal	1
Others (eg, skin diseases, gout)	6
Number of chronic conditions
1	8
2	6
3 or more	4
Type of medication (multiple possible)
Tablets	12
Inhaler	9
Injections	4
Nasal spray	2
Eye-drops	1
Powder	1
Topical cream	1

Abbreviation: COPD, chronic obstructive pulmonary disease.

Below, we first describe the MSM tasks that participants engaged in at work. After that, the impact of job characteristics, workplace culture, characteristics of medication regimes, and personal characteristics on MSM at work are described. Finally, the interactions of determinants and MSM behaviors are described. Some illustrative quotes are added to the text below; more quotes can be found in File S1 (Determinants of MSM at work) and File S2 (MSM behavior at work).

3.2. Medical management: practical organization of medication use at work

Of the 18 participants, 15 were taking medication at work. Most participants took only as-needed medication at work when symptoms arose (eg, with asthma or pain). Four participants (also) took their regular medication at work. For most participants, the prescribed medication regime fell outside of their work hours. Some deliberately shifted their medication intake to outside work schedules, because of the hassle of bringing medication to work, having medication that was difficult to administer at work, not wanting others to notice, or the ease of taking all medication simultaneously (in the morning and/or evening). Some participants planned medication intake to maximize effectiveness or minimize side effects that could impact their ability to work, particularly with pain medication or sleep medication. Some limited their medication intake, despite experiencing health complaints at work. Medication intake was sometimes delayed or skipped during busy or chaotic workdays, during evening shifts, or when walking away was difficult. Occasionally forgetting to bring medication to work led to delayed intake, leaving the workplace, asking relatives, or borrowing from colleagues:

Yes, I forgot that sometimes. But then I know a colleague who has migraines and who also has those powders, and then I ask for one of those. Or I drive home very quickly, which is dangerous, but then I just say: 'I'm going home now, because I feel my cluster headache coming on and I don't have any medication. (p01)

Most participants took medication behind their desk, on the go, during lunch breaks, or quickly in between activities, whereas a few participants required more time or facilities.

3.3. Emotional management: coping with (self-)stigma and psychosocial impact

The majority of participants said that, in general, they were not greatly troubled regarding their medication use at work:

Honestly, I am not really bothered by it. I take my medications in the morning, go to work, and it doesn’t affect me anymore. (p06)

Still, participants described that their medication use confronted them and others around them with their reality of having a chronic condition, conveying feelings of discomfort, self-consciousness, shame, and rejection. Some feared being seen as a burden or being treated differently:

In the end, it is a form of rejection. It is very stigmatizing, and you don’t want that. You don’t want to be judged for something you have, but for who you are or what you do. (p02)

Participants used humor, actively chose not to be preoccupied by it, or tried to put their own situation into perspective to deal with these emotions:

When I was a child, I found it much more troubling, because everybody pities you. And now I think: Well, nowadays everyone has something. Such things no longer surprise us. (p11)

Some described that they chose to be open about medication use to increase understanding and awareness of the impact of their medical condition towards co-workers. A few participants stated that their own positive attitude also positively affected their colleagues. At the same time, other participants deliberately avoided medication use at work, actively concealed medication use or found workarounds, to avoid being confronted by their own or others’ perceptions and behaviors regarding their chronic condition.

3.4. Role management: managing the impact of medication (use) on work tasks and responsibilities

For most participants, medication aided participation and performance at work through increasing overall health and well-being and easing emerging symptoms and health complaints. Nevertheless, participants continually had to find a (new) balance between work responsibilities and the use and impact of medication. Side effects sometimes hindered the ability to work, leading to canceling or postponing work, compromising work quality (eg,, reduced focus), or persevering, that is, “powering through.” For most participants, small breaks during the workday were sufficient to allow for medication administration or to deal with side effects. Some actively informed colleagues or arranged substitute coverage if their medication administration or side effects required that. A few participants refrained from specific tasks that increased the need for medication and/or exacerbated health complaints. Some participants shifted their work hours to deal with side effects, whereas others planned or adjusted their medication intake to accommodate their work and workability.

3.5. Treatment characteristics that affect MSM at work

Treatment characteristics mainly affected the complexity of MSM at work, and severity of side effects. Easy to administer medication—such as tablets and inhalers—made taking medication at work at most a slight inconvenience. When application was more complex—such as applying cream or measuring blood sugar—or when medication had delayed onset, medication use at work became more burdensome. Having to take medication with food, or food-adjusted dosing was difficult for some, especially on busy workdays, when lunch was postponed, or when timing and content of meals were uncertain. In general, a daily medication routine was helpful for adequate MSM at work, whereas changes in medication regimen or experiencing new side effects were challenging. When medication was needed for direct relief of symptoms, participants were more likely to use the medication at work, whereas others postponed their intake when no direct consequences were noticed. Technological developments, such as automatic glucose monitors or smaller and quieter inhalers, made medication use at work easier.

3.6. Beliefs and attitudes of the employee regarding taking medication at work

Most participants had a neutral or positive attitude toward using medication at work, accepting that it is part of them and has to be done. Some also regarded dealing with MSM at work as their own responsibility. These attitudes helped to incorporate MSM into work schedules, to request work adaptations, and to cope with the effects on workability. For other participants, MSM at work felt like a hassle or inconvenience. About half of the participants preferred to be open about their medication use. For some others, medication use was a private matter, and they perceived no relevance in discussing it. Participants described that positive past experiences, as well as being experienced, aided MSM at work, whereas negative experiences led to increased burden or the need for different strategies. The perceived need for medication and the (self-assessment of the) ability to adjust medication regimes affected the extent to which participants adjusted their medication intake at work.

3.7. Job characteristics that affect MSM

Most participants found that their work conditions provided sufficient flexibility and autonomy to integrate MSM into the workday. Working from home removed stressors, increased opportunities to take a rest, and made it easier to (remember to) take medication or handle side effects:

When I do office-based work, I occasionally work from home for a day when things are not going as well. That makes it easier to keep track of the time or set an alarm. That is much easier than when I work on the group [E.A.: in a care facility] because you get caught up in the pace of the day. That is also much more strenuous. (p16)

However, elevated work stress, evening shifts, unpredicted situations, and changes in work schedules increased health complaints, disturbed medication needs (eg, by increasing blood sugar levels), or resulted in postponing or forgetting to take medication. Also, busy work circumstances hindered monitoring the effects of new medication:

The doctor prescribed Levodopa [medication for Parkinson’s] at the start of December. But then I am always very busy. In January and February, the question was whether it helped. Well, I couldn’t really tell, so we stopped with it. (p02)

Work can also reduce or mask the presence or severity of health complaints, lowering the perceived need for medication. For some participants with asthma, circumstances at work (eg, poor air quality or allergy-triggering situations) elevated their medication need. Being self-employed increased autonomy and flexibility to make adjustments during workdays to better cope with MSM and illness burden at work although the responsibilities and (self-induced) work pressure could lead to increased work burden and health complaints. The self-employed and those in management positions also noticed that using medication had negative effects on the perception and expectations that employees and clients had of them.

The presence of appropriate facilities (eg, a restroom) enabled the private and/or hygienic administration of medication and offered the possibility to rest or recover, although some participants hassled with the lack of (shelf-)space, comfort, hygiene, or discreetness:

I do that [taking insulin] at the worst place you can think of: the toilet. It is always discouraged, you should not want that because of hygiene. But I don’t think I should do it in the presence of others. It is confronting for people. I don’t want to bother others with it, and I don’t feel the need to show it either. (p18)

A few participants mentioned that working in a medical or social sector increased understanding or practical advice from colleagues, whereas another participant was troubled by the increased pressure to be open, driven by the social nature of their job.

3.8. Employer and colleague support in medication use at work

Good relationships, open communication, transparency, and clear mutual expectations were important factors in being able to manage work and illness, making it easier to express oneself and ask for help or work adjustments. It also enabled employers and co-workers to accommodate participants’ needs or to facilitate appropriate responses in case of an adverse event or emergency:

I have some colleagues I get along with very well, and when I say I am not doing so well, they understand that there is more going on. They know I don’t easily speak up. If I do, they definitely take it into account. (p16)

Supportive employers mainly provided the possibility to take a break to administer medication or to rest, to resume work at a different time, or to work from home. Some participants noticed an “over-protective” attitude from their employer or colleagues, whereas others experienced stigma at work surrounding their condition and their medication, or a general stigmatizing attitude towards people with any chronic condition:

My previous employer found out second hand. He confronted me with it and actually insinuated that I had kept it from him. Even though he knows I have the freedom [to conceal]. I found that very difficult and harsh, because that almost sounds like I am a liar. [….] I am happy to have a fixed contract now, so that doesn’t play a role anymore. But still, in business, if they want to get rid of you, they do that anyway. (p09)

3.9. The interplay between work context, personal characteristics, and MSM tasks: cumulative complexities and interactions

Participants shared many examples of how contextual factors impacted MSM at work, but these factors played out differently across people or situations. It was often the interaction or cumulation of these contextual and personal factors that determined the complexity of MSM at work. This cumulative complexity was mainly manifested in 3 challenges regarding medication management at work: (1) practical complexity of integrating medication use in the workday, (2) the severity and impact of health complaints and side effects, and (3) the level of anticipated or experienced stigma and unwanted attention. For many participants, these 3 challenges determined the extent to which MSM is seen as doable or complex. They also influenced whether and how the 3 domains of MSM are applied. Figure 1 displays this manifestation of cumulative complexity and the relation to MSM behaviors at work. Although the use of medical devices was not the subject of this study, the accumulation of complexity is well illustrated by the example of 1 participant, who compared their inhaler use to having a catheter:

Figure 1.

Medication self-management and work.

If you’d ask what bothers me more in relation to work: having to use my catheter is much more complicated in work and social life than using an inhaler, because: you must always carry it with you. And you don’t want everyone to see you going to the toilet. And you always need a clean toilet. So that limits me much more. (p13)

The lower part of Figure 1 illustrates how the 3 elements of MSM at work are not stand-alone elements, but interact with one another. Stances on and experiences with emotional management (ie, acceptance, stigma, and disclosure) often influence the content of the practical medical management, since the question whether to openly use medication or not plays an important role in if and how medication is used. Following this, the complexity and impact of practical medical management dictate the extent to which role management is required. Although self-management tasks are implemented as a response to (potential) challenges, interactions between these tasks can also result in new challenges. This is illustrated by the 2-way arrows in Figure 1, linking the cumulative complexity to MSM behaviors. For example, concealment was applied by some participants to minimize stigmatizing behaviors of colleagues, but having to conceal medication at work complicated the practicalities of taking medication at work. Additionally, MSM at work becomes especially challenging when there is a conflict between different roles, that is, between being an individual with a chronic condition and being an employee:

Maybe I don’t fully accept that I have a chronic condition, which results in that my daily life and work have priority over taking good care of myself. […] I try to do it as good as I can, but I also just want to live a normal life and find enjoyment in my work. So, I don’t go to the extremes but find the perfect balance for me. (p18)

Furthermore, applying MSM behaviors and assessing their effectiveness to address complexity and imbalances occur in a feedback loop and learning circle, where participants experiment and, when insufficient, adjust their strategies:

I am usually a very open person, but these experiences […] When I got back from living abroad, I thought: I should not be ashamed because of my illness. So, then I started to share that during interviews. I didn’t get hired anywhere. And the moment I stopped talking about it, I got the job. […] So now I don’t feel like being open anymore. So, when I am traveling with a colleague, I absolutely don’t take my medications in sight. (p09)

4. Discussion

This study shows that incorporation of MSM into working life is often perceived as “doable” and considered an inherent, manageable aspect of living with a chronic condition, due to already established routines, implemented strategies, positive attitudes, and support from both colleagues and employers. Nonetheless, barriers that can lead to difficulties with MSM and MSM-related burden at work were identified.

We found that beyond individual factors, it is actually a cumulation of factors that make successful MSM at work challenging. This cumulative complexity is often an interplay between challenges with integrating medication use into the workday, the degree of side effects and health complaints, and people’s perceptions around openness. Unfavorable working conditions (ie, busy or stressful workdays, breaking regular routines, or unsupportive colleagues) can further add to the challenges of MSM at work. Previous research shows that ease of use of the medication predicts its use at work,³ to which our study adds that this ease of use is not only a property of the medication itself, but also is impacted by the work context and people’s preferences regarding how to use the medication at work, for example, visibly or not. Complex medication regimes and experiencing side effects result in higher perceived burden.^8,26 Still, medication burden is characterized by subjective experiences.⁷ Notably, medication use appears to be an integral aspect of illness and illness burden. Experiences of burden and impact at work were more often related to the chronic condition itself, than to MSM in particular, and during the interviews participants often circled back to discussing the “full package” of having a chronic condition at work.

To manage the complexity of MSM at work, medication intake was delayed, skipped, or shifted to outside working hours. This flexibility can be regarded as an element of “successful” self-management,²⁷ but can also lead to nonadherence, potentially affecting treatment effectiveness.^28,29 Some participants experienced a lack of appropriate facilities, for example, a lack of shelf space, poor hygiene, or inadequate privacy in restrooms, to administer medication. Studies among people with diabetes¹⁶ and asthma^15,19 also revealed a need for and/or lack of such spaces. Our study shows that even when employers comply with legal requirements to provide appropriate facilities,³⁰ employees do not always experience them as sufficient or pleasant for medication administration.

Generally, medication use was found to be beneficial for work, by solving or suppressing physical complaints and increasing functioning, which is underscored by Carls et al.³¹ Most participants were not limited in their ability to work because of MSM and were able to work with or around their medical treatment. Colleagues played a minor role in MSM tasks, perhaps since MSM is mostly an individual task for which people take more ownership and delegate less work to others compared with other self-management tasks.³²

Nonetheless, employers and colleagues can be very important in limiting MSM burden by providing a safe working space for people with chronic conditions,^17,33 since MSM was found to affect (social) well-being at work. Openly using medication allowed people to be fully themselves, whereas others worried over how they are treated because of medication use (eg, stigma, job security, or pity), more often recognized as aspects of treatment burden.³⁴ We found that stigma plays an important role in MSM at work, since perceptions of (anticipated) stigma can determine how people use their medication at work and how they cope with side effects and impact on work. In our study, we found a combination of different domains of stigma (eg, public, enacted, anticipated, and self-stigma), but exploring this in depth is a subject for future research.

Furthermore, being able to provide support requires awareness, but our study showed that opinions and practices regarding disclosure differed greatly. It is important for individuals with a chronic condition to be able to make their own informed disclosure decision,^35,36 for which disclosure decision aids can be helpful tools.³⁷ However, our study indicates that this decision cannot always be taken voluntarily when medication use is involved, since visibly using medication acts as a “disclosure vessel.”

Our study also shows that the 3 self-management tasks are all performed in the work setting and cannot be seen independent of one another. This corresponds with the suggestion of Cadel et al⁶ that it is crucial to consider all 3 tasks in efforts to improve medication self-management. For example, only addressing the medical management (ie, assisting people in aligning their insulin needs with the demands of their workday) would be less effective if feelings of shame are not addressed, or when there is no suitable facility at work to administer the medication.

Finally, our study shows that self-employment increases freedom and flexibility to adapt working schedules to MSM, but also increases the pressure to perform and sustain a business, which can be difficult when dealing with a chronic health condition.³⁸ Additionally, self-employed people struggle with the implications that disclosure can have on employees’ and clients’ perceptions of them,³⁸ in which MSM acts as an complicating factor.

4.1. Strengths and limitations

Looking at individuals’ experiences with MSM and treatment burden from their own perspective, considering the real-life situations and contexts in which medication is managed, provided valuable new insights. The sampling strategies in this study yielded a high variety in medication regimes, job types, and chronic conditions, which resulted in rich data. Dutch practices, regulations, and work-related culture may have shaped the findings of this study. Specifically, the impact of factors influencing MSM at work that may be specific to The Netherlands likely stems from cultural norms (eg, stigma levels, prevailing attitudes) and/or systemic or contextual conditions (eg, job security, workplace flexibility, and the noninvolvement of employers in medication subscription and distribution). Although these elements are not specific for The Netherlands, their impact may vary across countries, which could affect the generalizability of our findings. Due to voluntary self-selection of participants, selection bias may have influenced the results. As is common in qualitative research, the research team’s positionality may have influenced data collection and interpretation. The researchers’ professional background as well as personal experience with medication use at work may have enhanced understanding but also shaped interpretation of participants’ accounts. The researchers’ independence from participants’ workplaces likely facilitated openness. Finally, individuals who face greater challenges in balancing work with MSM, or chronic disease management in general, may have already left the workforce due to these challenges and were outside the scope of this study due to our selection criteria.

4.2. Implications and recommendations

The findings of this study have several implications for both research and practice. Firstly, balancing MSM with work can lead to (undesirable) adjustments in medication and potential nonadherence. Health care professionals and pharmacy staff should be alert to patients adjusting their medication and address this in consultations, especially for medications where adjustments are more likely (eg, due to complexity or stigma) or pose significant risks. This also requires health care professionals to be informed about their patients’ work status and working conditions. Secondly, the diverse nature of experiences with MSM at work suggests that improvement of MSM in the context of work requires tailored solutions with attention for individuals’ circumstances, needs, and attitudes, and the unique combinations of determining factors. The findings of this study suggest that such efforts should include all 3 MSM tasks, enabling people to find their preferred balance between medication management, role management, and emotional management. Further research is required to identify support needs of individuals regarding MSM at work. Specific attention should be paid to self-employed people, whose needs and access points may differ from those of employed people. Thirdly, decision aids regarding concealment or disclosure at work should be updated to include information on using medication visibly. Fourthly, although this study provided insights into the many contextual and personal factors that affect MSM at work, further research would be needed to verify the prevalence of and relationships between the various hindering and enabling factors of MSM at the workplace. Researchers should be aware that both the determinants as well as the MSM behaviors in the work context should not be studied in isolation, due to the connectedness of them that was found in this study. Our findings show that the impact of (perceived) stigma and the adaptations in medication may be of specific interest for further studies. Finally, it is important for employers and occupational specialists to address and foster an inclusive workplace culture that supports employers using medication. In this, they should be attentive to the boundaries and preferences of the individual employee with regards to (discussing) medication use at the workplace. The extent to which there is room for/acceptance of having a chronic condition and using medication can affect the effectiveness of MSM, the preparedness to ask for and provide required workplace adjustments, and the provision of an overall safe and supporting work environment.

Author contributions

All authors made a significant contribution to the work reported, whether in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; all took part in drafting, revising, or critically reviewing the article; all gave final approval of the version to be published; all have agreed on the journal to which the article has been submitted; and all agree to be accountable for all aspects of the work.

Funding

Participants in this study were recruited via the NPST research program, which is financed by the Dutch Ministry of Health, Welfare and Sports and the Ministry of Social Affairs and Employment.

Conflicts of interest

The authors report no conflicts of interest.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.