Evaluating Mental Health Literacy in the Workplace: Development and Psychometric Properties of a Vignette-Based Tool

Digital Training Program for Line Managers (Managing Minds at Work): Protocol for a Feasibility Pilot Cluster Randomized Controlled Trial

BACKGROUND

Mental health problems affect 1 in 6 workers annually and are one of the leading causes of sickness absence, with stress, anxiety, and depression being responsible for half of all working days lost in the United Kingdom. Primary interventions with a preventative focus are widely acknowledged as the priority for workplace mental health interventions. Line managers hold a primary role in preventing poor mental health within the workplace and, therefore, need to be equipped with the skills and knowledge to effectively carry out this role. However, most previous intervention studies have directly focused on increasing line managers' understanding and awareness of mental health rather than giving them the skills and competencies to take a proactive preventative approach in how they manage and design work. The Managing Minds at Work (MMW) digital training intervention was collaboratively designed to address this gap. The intervention aims to increase line managers' knowledge and confidence in preventing work-related stress and promoting mental health at work. It consists of 5 modules providing evidence-based interactive content on looking after your mental health, designing and managing work to promote mental well-being, management competencies that prevent work-related stress, developing a psychologically safe workplace, and having conversations about mental health at work.

OBJECTIVE

The primary aim of this study is to pilot and feasibility test MMW, a digital training intervention for line managers.

METHODS

We use a cluster randomized controlled trial design consisting of 2 arms, the intervention arm and a 3-month waitlist control, in this multicenter feasibility pilot study. Line managers in the intervention arm will complete a baseline questionnaire at screening, immediately post intervention (approximately 6 weeks after baseline), and at 3- and 6-month follow-ups. Line managers in the control arm will complete an initial baseline questionnaire, repeated after 3 months on the waitlist. They will then be granted access to the MMW intervention, following which they will complete the questionnaire post intervention. The direct reports of the line managers in both arms of the trial will also be invited to take part by completing questionnaires at baseline and follow-up. As a feasibility pilot study, a formal sample size is not required. A minimum of 8 clusters (randomized into 2 groups of 4) will be sought to inform a future trial from work organizations of different types and sectors.

RESULTS

Recruitment for the study closed in January 2022. Overall, 24 organizations and 224 line managers have been recruited. Data analysis was finished in August 2023.

CONCLUSIONS

The results from this feasibility study will provide insight into the usability and acceptability of the MMW intervention and its potential for improving line manager outcomes and those of their direct reports. These results will inform the development of subsequent trials.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05154019; https://clinicaltrials.gov/study/NCT05154019.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48758.

Mental Health in Farming Communities

Occupational stressors are causing unprecedented levels of stress, depression, and suicide among our nation's farmers, and little is known about how farmers view their personal stress and potential stress-relieving strategies. The current study used a descriptive qualitative approach to conduct focus groups comprising farmers and farm family members (N = 26). Participants were recruited using a snowball approach based on the investigators' connections to farming communities. Preliminary analysis indicates that primary stressors are: lack of control over many aspects of farming and the public's lack of understanding/appreciation for farming. In addition, two communities identified high levels of anticipatory stressors. Despite these stressors, they continue to farm because of their love for farm life and their generational connection with the land. To decrease farmer stress, participants suggested educating the public about farm life and the impact farming has on the general public, creating social groups for farmers to talk to each other, and sharing the farmer story. [Journal of Psychosocial Nursing and Mental Health Services, 61(10), 39-43.].

An Integrated Approach to Workplace Mental Health: A Scoping Review of Instruments That Can Assist Organizations with Implementation

This study aimed to identify instruments that may assist organizations with implementing an integrated approach to workplace mental health using three activities from the knowledge to action (KTA) framework. A scoping review of published and grey literature, supported by stakeholder (business end-user and researcher) consultation, identified work-specific instruments that were relevant to at least one of the three domains of an integrated approach to workplace mental health: 'prevent harm', 'promote the positive', and 'respond to problems'. A total of 207 instruments were located, and 109 instruments met eligibility criteria. 10 instruments were located that were relevant to multiple domains, however most instruments (n = 72) were relevant to the 'prevent harm' domain. Instruments relevant to the 'promote the positive' (n = 14) and 'respond to problems' (n = 13) domains were limited. Most instruments found were suitable for the 'monitor, review and improve' KTA activity. Further development of instruments that can assist with 'promote the positive' and 'respond to problems' strategies are required, specifically those instruments that can assist organizations with the 'identify gaps and opportunities' and 'identify priorities and design new/enhanced interventions' KTA activities.

Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021

BACKGROUND

It has been about 30 years since the first health literacy instrument was developed. This study aimed to review all existing instruments to summarize the current knowledge on the development of existing measurement instruments and their possible translation and validation in other languages different from the original languages.

METHODS

The review was conducted using PubMed, Web of Science, Scopus, and Google Scholar on all published papers on health literacy instrument development and psychometric properties in English biomedical journals from 1993 to the end of 2021.

RESULTS

The findings were summarized and synthesized on several headings, including general instruments, condition specific health literacy instruments (disease & content), population- specific instruments, and electronic health. Overall, 4848 citations were retrieved. After removing duplicates (n = 2336) and non-related papers (n = 2175), 361 studies (162 papers introducing an instrument and 199 papers reporting translation and psychometric properties of an original instrument) were selected for the final review. The original instruments included 39 general health literacy instruments, 90 condition specific (disease or content) health literacy instruments, 22 population- specific instruments, and 11 electronic health literacy instruments. Almost all papers reported reliability and validity, and the findings indicated that most existing health literacy instruments benefit from some relatively good psychometric properties.

CONCLUSION

This review highlighted that there were more than enough instruments for measuring health literacy. In addition, we found that a number of instruments did not report psychometric properties sufficiently. However, evidence suggest that well developed instruments and those reported adequate measures of validation could be helpful if appropriately selected based on objectives of a given study. Perhaps an authorized institution such as World Health Organization should take responsibility and provide a clear guideline for measuring health literacy as appropriate.

Association of stigmatizing attitudes with people’s opinion of depression as a valid reason for sickness absence: A Swedish vignette study

BACKGROUND: Depression is a common cause of sickness absence (SA) and also highly associated with stigma. Few studies have addressed the role of stigma in relation to SA. OBJECTIVE: To investigate if attitudes to depression were associated with the public’s opinion of depression as a valid reason of SA. METHODS: The study population (n = 2413) originated from a web-based panel of citizens. The survey included a short vignette describing a person with symptoms of depression and the person’s work tasks, followed by a question on recommendation of SA. Negative attitudes were measured by the Depression Stigma Scale. Logistic regressions were used to estimate the odds ratios (OR) for the likelihood of not recommending SA, controlling for individual and work-related co-variates. RESULTS: The crude association between negative attitudes and not recommending SA was OR 2.15 (95% CI, 1.76–2.62). In the fully adjusted model the OR was 1.76 (95% CI, 1.40 –2.21) for not recommending SA. CONCLUSIONS: Participants with negative attitudes to depression were more likely to not consider depression as a valid reason of sickness absence. The study supports theories on layered stigma; attitudes from one arena are related to other arenas. Future studies are needed to confirm our findings.

Decision (not) to disclose mental health conditions or substance abuse in the work environment: a multiperspective focus group study within the military

OBJECTIVES

Many workers in high-risk occupations, such as soldiers, are exposed to stressors at work, increasing their risk of developing mental health conditions and substance abuse (MHC/SA). Disclosure can lead to both positive (eg, support) and negative (eg, discrimination) work outcomes, and therefore, both disclosure and non-disclosure can affect health, well-being and sustainable employment, making it a complex dilemma. The objective is to study barriers to and facilitators for disclosure in the military from multiple perspectives.

DESIGN

Qualitative focus groups with soldiers with and without MHC/SA and military mental health professionals. Sessions were audiotaped and transcribed verbatim. Content analysis was done using a general inductive approach.

SETTING

The study took place within the Dutch military.

PARTICIPANTS

In total, 46 people participated in 8 homogeneous focus groups, including 3 perspectives: soldiers with MHC/SA (N=20), soldiers without MHC/SA (N=10) and military mental health professionals (N=16).

RESULTS

Five barriers for disclosure were identified (fear of career consequences, fear of social rejection, lack of leadership support, lack of skills to talk about MHC/SA, masculine workplace culture) and three facilitators (anticipated positive consequences of disclosure, leadership support, work-related MHC/SA). Views of the stakeholder groups were highly congruent.

CONCLUSIONS

Almost all barriers (and facilitators) were related to fear for stigma and discrimination. This was acknowledged by all three perspectives, suggesting that stigma and discrimination are considerable barriers to sustainable employment and well-being. Supervisor knowledge, attitudes and behaviour were critical for disclosure, and supervisors thus have a key role in improving health, well-being and sustainable employment for soldiers with MHC/SA. Furthermore, adjustments could be made by the military on a policy level, to take away some of the fears that soldiers have when disclosing MHC/SA.

Work-Related Health Literacy: A Scoping Review to Clarify the Concept

The overall aim of this scoping review is to outline the current state of research on health literacy (HL) in the workplace: the primary objective is to clarify the concept of individual work-related HL; the secondary aims are to report on interventions that promote individual work-related HL and to present respective measurement instruments validated to date. A high level of work-related HL could support work ability and in the longer run employability. These topics are becoming increasingly important in current circumstances and in view of ongoing developments (e.g., digitalization and "new" work). A basic understanding and measurement of HL as an individual competence in the context of working life is necessary to develop future interventions to promote HL among people of working age. According to the participants, concept, and context (PCC) framework, we included articles on health literacy (concept) in the target group of people of working age in the workplace (population and context). Key information sources were the databases PubMed, CINAHL, PsycInfo, and PSYNDEX. A total of 30 articles were included. There are several terms for "health literacy in the workplace" (including individual work-related or occupational HL). The conceptualizations of the individual employee's competence covered all aspects of HL ("access", "understand", "appraise", and "apply" health information). The conceptualizations differed, among others, in the covered time horizon (referring either only to employees' current work situation or additionally to their employability in the lifespan) or whether they referred also to the viability of the respective company. Published interventions attempting to promote individual work-related HL seem mostly to be targeted at the promotion of mental HL. A variety of outcomes have been measured in intervention studies, while specific measurement instruments for individual work-related HL seem to be scarce. We recommend the development of country-specific instruments for the assessment of individual work-related health literacy and to measure mental and physical work-related health literacy.

Corporate Application of Health Literacy

BACKGROUND

The growing concern of low health literacy in populations combined with the interest of companies to develop cultures of health and the emerging interest in the workplace as an arena for improving health literacy is increasingly acknowledged. This study aimed to explore how companies currently apply the concept of health literacy as part of their health efforts in the work sphere.

METHODS

A systematic literature review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. The search was performed in the databases PubMed, Science Direct, and Directory of Open Access Journals from July 2019 to August 2019 and included the search terms "health literacy," "health literate," and "health competence" combined with the search terms "company/companies," "corporation/corporates," "workplace," "business," and "organization." Studies were eligible for inclusion if they (1) were written in English or German, (2) were concerned with employers/employees, companies, corporations, or organizations, (3) dealt with health literacy in particular, and (4) were formatted as journal articles, systematic literature reviews, or book chapters.

KEY RESULTS

The search identified 20 articles. A thematic analysis resulted in 5 clusters with 2 to 3 sub-themes illustrating the characteristics of how corporations apply health literacy. The clusters entailed the conceptualization of health literacy, its measurement, and the application of health literacy in strategies, interventions, and training.

DISCUSSION

The literature review reveals that the application of health literacy by companies is in its infancy. More research and practical experience are warranted on how companies can mobilize and facilitate a health literate workforce. [HLRP: Health Literacy Research and Practice. 2021;5(3):e218-e225.] Plain Language Summary: This literature study explored the role of advancing health literacy in companies. Five aspects were identified as important, including the understanding of the concept, its measurement, and its integration into strategies, interventions, and training. The involvement of management and the staff was crucial for success.

Including Mental Health Screenings in Annual Wellness Programs

Mental health is an important component of overall wellness and is a growing concern in occupational settings. Approximately one half of Americans will experience a mental health disorder at some time in their life. The current descriptive correlational study used a convenience sample of manufacturing employees (N = 236) to examine the association of mental and physical health risks collected during an annual wellness program. A researcher-developed questionnaire was used to holistically screen for health risks. Pearson's r and chi-square tests were performed to determine the relationship among variables. Younger workers and individuals with higher body mass index had increased anxiety and depression scores (p = 0.005). Results suggest younger workers may have increased risk for mental health and biometabolic disorders. Due to the connections between mental and physical health, screening for anxiety and depression should be included in annual worker wellness programs to potentially improve overall health and wellness outcomes. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Developing and Establishing Content Validity of Vignettes for Health Care Education and Research

The use of vignettes in research and education is well documented. Documentation of how vignettes are developed and content validity is established, however, are rare. The purpose of this paper is to describe a method for development and establishing content validity of vignettes that can be used to assess student performance and research participant outcomes. This three-phase method was designed to validate seven vignettes for a future research project. Content validity index survey and expert panel interviews were used to inform improvements in validity. Findings showed that clinical vignettes were improved with respect to content relevance (from 0.93 to 0.96) and importance (from 0.68 to 0.93). Developing validated vignettes is essential when used to measure outcomes in education and in research. This three-phase method of vignette development and validation is feasible and effective in improving content validity of vignettes and can be used in other education and research projects.

Psychische Gesundheitskompetenz am Arbeitsplatz

Zusammenfassung. Das Mental Health Literacy tool for the Workplace (MHL-W; Moll, Zanhour, Patten, Stuart & MacDermid, 2017 ) ist ein vignettenbasiertes Instrument mit 16 Items zur Messung psychischer Gesundheitskompetenz im Arbeitskontext. Nach der Übersetzung ins Deutsche sowie einer Anpassung der Vignetten anhand einer qualitativen Expertenbefragung, wurde das MHL-W-G an zwei deutschsprachigen Stichproben mit 122 Studierenden sowie 317 Berufstätigen hinsichtlich Reliabilität, Konstruktvalidität, Messinvarianz, Geschlechtereffekte und Faktorstruktur analysiert. Erstmalig wurde die Faktorenstruktur (EFA/CFA) des MHL-W-G untersucht: Im Gegensatz zu dem von Moll et al. (2017) ursprünglich angenommenen einfaktoriellen Modell zeigte ein Modell zweiter Ordnung eine deutlich bessere Passung. Weiterführende Analysen ergaben gute interne Konsistenzen und Intraklassenkorrelationen. Die Ergebnisse deuten auf Messinvarianz des MHL-W-G unabhängig vom Geschlecht hin. Insgesamt lassen die psychometrischen Eigenschaften den Schluss zu, dass mithilfe des MHL-W-G psychische Gesundheitskompetenz am Arbeitsplatz reliabel und valide erfasst werden kann.

Establishment and validation of a mental health literacy measurement in Canadian educators

We aim to create the first mental health literacy measure addressing mental health knowledge of educators and assess its psychometric properties. We developed a 30-item multiple choice measure, Mental Health Literacy Tool for Educators (MHL-ED), with experts in both mental health and education. We administered it to educators (n = 909) from 6 Canadian provinces. We analysed the factor structure, internal consistency reliability, construct validity and responsiveness to change of MHL-ED. Factor analysis resulted in 4 factors of MHL-ED addressing: general mental illness and related treatment; assessment and diagnostic tools and treatments; causes and risk factors of mental illness; and epidemiology of mental health and mental illness. MHL-ED demonstrated strong internal consistency reliability. The construct validity was established because the hypothesis was supported that school based mental health professionals scored significantly higher than classroom teachers and school administrators/school support staff; and further MHL-ED scores were positively related with stigma measures. We did not identify floor or ceiling effects of MHL-ED. MHL-ED is reliable and valid to evaluate mental health literacy levels among educators working in junior high and secondary school settings, and may be considered for use in future research in this field.

Beyond Silence: A Randomized, Parallel-Group Trial Exploring the Impact of Workplace Mental Health Literacy Training with Healthcare Employees

OBJECTIVE

This study sought to evaluate whether a contact-based workplace education program was more effective than standard mental health literacy training in promoting early intervention and support for healthcare employees with mental health issues.

METHOD

A parallel-group, randomised trial was conducted with employees in 2 multi-site Ontario hospitals with the evaluators blinded to the groups. Participants were randomly assigned to 1 of 2 group-based education programs: Beyond Silence (comprising 6 in-person, 2-h sessions plus 5 online sessions co-led by employees who personally experienced mental health issues) or Mental Health First Aid (a standardised 2-day training program led by a trained facilitator). Participants completed baseline, post-group, and 3-mo follow-up surveys to explore perceived changes in mental health knowledge, stigmatized beliefs, and help-seeking/help-outreach behaviours. An intent-to-treat analysis was completed with 192 participants. Differences were assessed using multi-level mixed models accounting for site, group, and repeated measurement.

RESULTS

Neither program led to significant increases in help-seeking or help-outreach behaviours. Both programs increased mental health literacy, improved attitudes towards seeking treatment, and decreased stigmatized beliefs, with sustained changes in stigmatized beliefs more prominent in the Beyond Silence group.

CONCLUSION

Beyond Silence, a new contact-based education program customised for healthcare workers was not superior to standard mental health literacy training in improving mental health help-seeking or help-outreach behaviours in the workplace. The only difference was a reduction in stigmatized beliefs over time. Additional research is needed to explore the factors that lead to behaviour change.