Process- and Life-World-Oriented Evaluation in Vocational Rehabilitation

The German rehabilitation system promotes social and occupational inclusion for individuals with chronic illness or diminished work ability, focusing on participation. The FaKT model project—"Case Management in the Context of Diminished Work Ability"—implements an outreach-oriented intervention for those with oncological or neurological conditions. Using a mixed-methods research design, we evaluate the effectiveness and impact of the intervention, focusing on participants' perspectives. Our approach follows modern qualitative health evaluation research, emphasising process-oriented and life-world integration as per the International Classification of Functioning, Disability and Health (ICF). Through interviews, observations, family interviews, and standardised questionnaires, we aim to understand how participants experience health transitions. Our findings suggest a need to redefine evidence in rehabilitation evaluation. Traditional paradigms, focusing on experimental and quantitative outcomes, inadequately capture the transformative and negotiated aspects of rehabilitation. Qualitative methodologies are essential for revealing contextual conditions, unintended effects, and locally defined success metrics within rehabilitation. The limitations of evidence-based research are apparent in accessibility challenges and the exclusion of diverse populations. Our sample often overrepresents urban participants interested in research, while rural and marginalised groups are underrepresented due to participant-related and institutional barriers. To address disparities, we adjusted our research design by collecting socio-demographic data through questionnaires and actively engaging marginalised participants via telephone or in-person interviews. For rural participants, we collaborate with local stakeholders for travel support. Recognising qualitative evidence-based methods within the FaKT project enables us to better evaluate the intervention's effectiveness and impact by identifying and addressing specific participant needs. This is more insightful than solely using quantitative methods. Integrating qualitative methodologies enhances our understanding and facilitates a comprehensive evaluation of case management. This approach ensures that interventions are tailored to meet the diverse and context-specific needs of all participants, promoting a more equitable rehabilitation system.