| Summary: | Background: Unemployment and reduced work capacity among people managing Chronic Kidney Disease (CKD) receiving haemodialysis (HD) treatment is high. Whilst we know the treatment is time consuming and patients experience numerous symptoms which hinder their ability to work, there is limited research on how work is sustained and what strategies would retain people with CKD in the labour market. Aim: The thesis examines employment status, and sustainability of work among HD patients in Kingdom of Saudi Arabia (KSA). Methods: A mixed method sequential explanatory approach was used. Phase one (quantitative) administered the Work Productivity Activity Impairment Tool, demographic questionnaire and SF-12: to examine employment status, functioning and wellbeing, work productivity and activity impairment. Phase two (qualitative) adopted semi-structured interviews to generate a deeper understanding of who, what, why and how HD patients continue to work, or not, alongside managing a long-term condition. The research was conducted across two study sites in Riyadh province, targeting a population of people of working age (aged 18-65 years) receiving HD. Results: 130 patients completed phase one, 51% male with a mean age 42 years. Only 25% of participants were in employment, predominantly men (91%), reflecting the male dominated labour market of KSA. Physical condition, age and gender were significant predictors for unemployment. For those people employed, 74% reported lost work productivity, and 57% reported activity impairment (employed and unemployed). A convenience sample of 16 patients were interviewed in phase two. Health condition, absence of work ethic, discrimination and policy abuse, social and cultural norms, lack of understanding and support were directly related to a person’s impaired activity and ability to sustain employment. Conclusion: This innovative study tested a measure that generated an evidence base to expose the impact of CKD on the labour market. The methodology was useful and replicable across similar countries at identifying productivity reduction and activity impairments among HD patients. In the context of KSA the study exposed unique cultural discrimination and policy abuse, highlighting the need for policy reform and introduction of alternative strategies to enable people with a long-term condition to sustain employment.
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