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Background Evidence of a positive association between work and health has been gathering up for years and can be explained by social status, contributions to society and the self-worth that work provides. This is maintained through the ideal of work ethic, where working is seen as the moral way of life. Not living up to the morally worthy identity can cause feelings of inadequacy, shame and stigmatisation. Considering this, it is relevant to investigate how people on sick leave manage societal norms and values related to work, and how this influences the sick leave and rehabilitation process. The literature on return to work is extensive and has investigated the issue from different perspectives. How norms influence the return to work process and how individuals and other stakeholders relates to such norms are less commonly explored, which is the focus of the present study. Methods This was a longitudinal interview study with a narrative approach, comprising 38 interviews with 11 individuals on long-term sick leave. Data collection was conducted in two phases and analysed iteratively through content analysis. Results The results suggest that work ethics and societal norms influence individuals' views of themselves and the sick leave and rehabilitation process. Conforming one's personal values to the work norm can create internal conflicts and cause feelings of shame for not being able to live up to the established norm. The strong work norm may create unrealistic expectations, which in some cases may result in constraining the return to work process. Conclusions To transform a sick leave narrative into a positive one, societal norms and their influence on identity needs to be recognised. Stakeholders involved in the process can contribute to a positive transformation by not only supporting return to work, but also to acknowledge and help people manage their self-image as having a disability that limits their ability to work. Key messages Full return to work is not always the best option from a quality of life and well-being perspective. Treatment and support from stakeholders should be viewed as meaningful and legitimate, even if it does not lead to return to work.

Work ethic and societal norms influence sick leave and return to work: Tales of transformation