Background: Digital work can be cognitively challenging especially for people with cognitive difficulties. New occupational therapy interventions are needed to empower these persons to self-manage challenges in digital work and everyday life. To address this need, the internet-based intervention ‘Strategies for Empowering Activities in Everyday Life’ (SEE 2.0) was tested.Aim: To explore and describe how SEE can support the development of self-management in people with cognitive difficulties who engage in digital work and other occupations in everyday life.Material and methods: A qualitative, descriptive case study included four participants with cognitive difficulties due to neurological disorders who participated in SEE. Data were collected through semi-structured interviews, self-reports and assessments then analysed using pattern matching.Results: Three cases were formed. Two cases (three people) adhered to SEE’s intervention process, resulting in increased work hours, improved occupational balance, and greater engagement in valued occupations. One case (one person) could not fully adhere to the process and struggled to adopt changes.Conclusions: SEE shows potential in supporting self-management, promoting sustainable digital work and everyday life.Significance: SEE can add to existing vocational rehabilitation programs by empowering persons to utilise their own resources to manage challenges in everyday life.

BACKGROUND: Digital work poses cognitive demands on all employees, but the impact is greater for employees with cognitive impairments. Digitalization also has significant implications for employer representatives as they are responsible for the work environment. However, knowledge is scarce concerning employer representatives’ perspectives on identifying needs and support for employees with cognitive impairments working in a digital work environment.

OBJECTIVE: To describe employer representatives’ experiences of work environment management with focus on employees with cognitive impairments working in a digital environment.METHODS:Focus group methodology was used. Six employer representatives with work environment responsibilities participated.

RESULTS: One overall theme “Mastering the interconnected processes in a transformative digital work environment” as well as three themes “Facilitating good digital work conditions”, “Identifying needs and difficulties in work tasks among employees’ with cognitive impairments” and “Pursuing knowledge and collaborations to support employees with cognitive impairments” with subthemes were identified. The themes describe employer representatives’ challenges and efforts to identify fluctuating needs in employees with cognitive impairments and, also, to organize and reduce cognitive demands in the work environment to support them.

CONCLUSIONS: Managing the challenges of an evolving digital work environment and matching individual work ability of employees with cognitive impairments in relation to cognitive demands is an ongoing process. The participants valued cooperation with employees with cognitive impairments but lacked support from expertise. The need to develop and implement a functioning support system for vocational rehabilitation to ensure a sustainable work in digital work environments is indicated.

The digitalization has changed the work life and created new cognitive demands that can be challenging to manage in digital work and everyday life for people with cognitive difficulties related to neurological disorders. Nevertheless, the consequences of these changes are largely unexplored. Thus, the overall aim of this thesis is to enhance knowledge of how people with cognitive difficulties experience digital work and other occupations in everyday life, and how to promote a sustainable digital work life.

The thesis comprises four qualitative studies. Study I explored and described how people with cognitive difficulties engaged in digital work, experienced their vocational situation and how it influenced their everyday life. This study was designed as a qualitative, descriptive, multiple case study. Data were collected through semi-structured interviews, self-reports and assessments from seven participants with neurological disorders and analysed using pattern matching. The findings suggest that performing digital work was cognitively demanding and influenced engagement in other valuable occupations. Work-related obligations were prioritized over other occupations in everyday life. Additionally, digital work was facilitated by support from employers and family, as well as by using self-initiated management strategies in challenging situations. 

Study II described how people with cognitive difficulties due to neurological disorders experienced their use of self-initiated strategies to manage digitalized work and other occupations in everyday life. Eleven participants participated in qualitative interviews, supported by a dialogue support tool. The findings of the qualitative content analysis imply that self-initiated management strategies were often crucial for managing challenging situations in digital work and to uphold engagement in occupations outside work. Having an ability to self-evaluate and reflect upon the use of strategies was necessary for a conscious, flexible and effective use. 

Study III described employer representatives’ experiences of work environment management focusing on employees with cognitive difficulties working in a digital environment. Focus group discussions with six employer representatives were utilised for data collection. The focus group analysis indicated that aligning the work abilities of employees with cognitive difficulties to the evolving cognitive demands of digital work, was a continuous process. Given the dynamic nature of both employee’s abilities and work demands, fostering a trustful relationship and collaboration with the employee was crucial. This ongoing process required knowledge of digital technologies, the impact of cognitive difficulties on work ability and support from and collaboration with other professionals with related expertise. 

Study IV, explored and described how an internet-based occupational therapy intervention can support self-management in people with cognitive difficulties performing digital work and other occupations in everyday life. The study was designed as a qualitative, descriptive, case study. Data were collected at three occasions from four people with neurological disorders participating in the intervention ”Strategies for Empowering activities in Everyday life” [SEE 2.0.]. Data gathered through semi-structured interviews, self-reports and assessments were analysed using pattern matching. The findings suggest that SEE 2.0 has the potential to support the development of self-management and initiate a process of change in people with cognitive difficulties, thus having the possibility to facilitate a sustainable digital work and everyday life. 

The enhanced understanding derived from this thesis can be used to develop vocational rehabilitation for people with cognitive difficulties in digital work. Taking a wider approach when evaluating and identifying cognitive difficulties and considering work and other occupations as an entirety rather than separate parts, is vital. This to facilitate sustained engagement in digital work and a balanced everyday life. It is also essential to have continuous supportive collaboration between employees and employers, as abilities and demands are in constant interaction and change in digital work. Finally, the thesis emphasizes the importance of utilising each person's own resources and strategies to empower self-management, to promote a sustainable digital work life.

Background: Digitalized work life can increase cognitive demands and influence people’s everyday life. This can be challenging for people with cognitive difficulties, yet there is scarce knowledge of how they manage these. It is essential to learn how self-initiated management strategies can be a resource to support sustainable work and everyday life.

Aim: To describe how people with cognitive difficulties due to neurological disorders experience their use of self-initiated strategies to manage digitalized work and other activities of everyday life. Material and Methods: Eleven employees in digital work with cognitive difficulties and neurological disorders participated in qualitative interviews supported by a dialogue support tool. Data were analyzed using content analysis.

Results: A complexity of strategies was used to manage digital work and other activities. Based on how strategies were applied, three different profiles were found. These reflected efforts to manage situations in everyday life and how these influenced strategies applied and their importance.

Conclusion: This knowledge can support people with cognitive difficulties and professionals to become aware of the potential of strategies and acknowledge a person’s own management resources. Reflections on how to manage situations can give perspectives on prevention or vocational rehabilitation to facilitate a sustainable work life.

Introduction: Digitalization has changed working life and increased cognitive demands on employees in general. Nevertheless, the consequences for employees with cognitive impairments and subjective cognitive difficulties are to a large extent unexplored. The aim of this study was to explore and describe how employees with subjective cognitive difficulties who are performing digital work tasks experience their vocational situation and how this situation influences their everyday life.

Methods: A qualitative, descriptive, multiple-case study was designed. Self-reports, assessments and qualitative interviews were used to collect data from the seven participants with neurological disorders. The data were analysed using pattern matching.

Findings: The analysed data formed four categories conceptualized as "Working to my full potential", "Working, but it is largely up to me", "Working at the expense of everyday life" and "Working without known difficulties", and these categories included one to four subcategories.

Conclusion: Managing subjective cognitive difficulties in vocational situations and everyday life was challenging in a digitalized working life for participants with neurological disorders. To provide equal access to preventive measures and rehabilitation and a sustainable working life, it is important to investigate the influence of subjective cognitive difficulties systematically on work, everyday life and management strategies in people with neurological disorders in digitalized work.