The Effects of a Cluster Randomized Controlled Workplace Intervention on Sleep and Work-Family Conflict Outcomes in an Extended Care Setting

Individual and organizational interventions to promote staff health and well-being in residential long-term care: a systematic review of randomized controlled trials over the past 20 years

BACKGROUND

Staff in residential long-term care (RLTC) experience significant physical and mental work demands. However, research on specific interventions to promote staff health and well-being in RLTC facilities is limited. This systematic review aimed to synthesize the current evidence on health promotion interventions among RLTC staff.

METHODS

A comprehensive systematic literature review was conducted on studies published between January 2000 and April 2023. Four electronic databases were searched, including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PsychArticles via EBSCO. The review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The methodological quality of the included studies was assessed using the Risk of Bias Assessment tool (RoB 2).

RESULTS

A total of 26 publications, referring to 23 different interventions with a randomized controlled design were included. Among these interventions, ten used training/educational approaches, six used behavioral approaches, and seven employed a multimodal approach. Significant improvements in health and well-being outcomes were found in four interventions using a training/educational approach, three interventions using a behavioral approach, and four interventions using a multimodal approach. Within the interventions studied, twelve specifically targeted the reduction of job demands, while only one intervention exclusively addressed job resources among RLTC staff. Furthermore, ten interventions addressed primary outcomes that encompassed both job demands and job resources.

CONCLUSION

Current evidence for health promotion interventions among RLTC staff is still limited, but research suggests that there is potential to improve certain outcomes related to RLTC staff health and well-being. Future research is recommended to contemplate a tailored intervention design that encompasses both individual-level and organizational-level approaches, and gender-specific physiological and sociological characteristics of RLTC staff. Moreover, detailed reporting of the development process, and research on the interaction between job demands and resources of RLTC staff are also recommended.

Interventions to reduce the risk of mental health problems in health and social care workplaces: A scoping review

Work in the health and social care sector is stressful, and work-related stress increases the risk of depression, anxiety, burnout, and sleep disorders. Although interventions to reduce stress and burnout at workplaces have been developed and studied, most studies have lacked the effectiveness to improve the situation. Thus, more knowledge on interventions and analysis of their mechanisms is needed to reduce the risk of more adverse mental health problems (MHP). We conducted a scoping review to identify the relevant literature on individual and organizational interventions to improve mental health in health and social care workplaces. Data were gathered on target groups, intervention types and their effectiveness, and the outcomes of the interventions. We summarized this data thematically. The final review consisted of 76 studies. Mental health interventions primarily focused on health care workers rather than social care professionals. The interventions were mostly directed at individual workers, ignoring organizational-level interventions. They used a great variety of outcomes and questionnaires, and the questionnaires that measured the outcomes were used ambiguously. In most cases, the reported effectiveness of the studied interventions was incoherent, and many of the interventions had both statistically significant and non-significant effects. Evidence that interventions reduce the risk of work-related MHP is scarce. High-quality randomized controlled trials of interventions to promote mental health with more coherently formed outcomes are needed, especially on the organizational level. More interventions to improve social care professionals' mental health are also needed.

Alleviating work-family conflict for female employees in Iran: The effect of a multimedia educational intervention

Work-family conflict can lead to irreparable losses to individuals, families and organizations. This matter is especially important for married working women who cannot eschew home responsibilities. To consider an appropriate intervention for this issue, we investigated the effect of a one-month intervention on support from the workplace and the family, individual characteristics and work-family conflict. This quasi-experimental longitudinal study includes an intervention group and a control group, and uses a pre-test, post-test and 6-months follow up design. Participants were 120 married women working in healthcare services, recruited from two cities in South Iran. The web-based multimedia educational program comprised four modules: one for each of the women participants, their spouses, their co-workers, and their workplace supervisors. Data collection tools included a demographic information form, and co-worker support, supervisor social support, spouse support, core self-evaluation and work-family conflict questionnaires. The effect of the intervention was examined at two post-intervention time points. A comparison of changes in mean scores between the intervention and control groups indicated that scores of supervisor support, spouse support, core self-evaluation and work-family conflict in the intervention group one month and six months after the intervention were all significantly improved compared to before the intervention. There was no benefit of the intervention in terms of a change in co-worker support. There was no significant difference across the three time points in the control group. These results confirm that online educational methods can enable health promotion professionals to reduce work-family conflict to the benefit of both employees and organizations.

My job impacts my sleep: signs and symptoms of insomnia among healthcare workers

Potential insomnia in healthcare workers is a public health concern as it may degrade the quality of patient care. We examined the prevalence of insomnia symptoms in healthcare workers and their perceived need for a sleep intervention. Participants were 62 nurses working full-time at a U.S. hospital. These nurses were asked about background characteristics, perceived stress, sleep concerns, and need for a sleep intervention. They also participated in 14-d ecological momentary assessment (EMA) and actigraphy sleep study. A qualitative analysis showed that the majority (92%) of participants reported at least one sleep concern with insomnia-related concerns being most prevalent (68%). Quantitative analyses indicated that those with insomnia-related concerns had higher perceived stress overall and lower EMA sleep sufficiency and sleep quality. Moreover, participants with insomnia concerns had shorter actigraphy-measured nap duration prior to non-workdays than those without. Nearly all (95%) expressed interest in participating in a sleep intervention; an online format and mindfulness contents were most preferred. Our results suggest a high prevalence of insomnia symptoms and a high interest in a sleep intervention in nurses. Information obtained from this study could be used to deliver a tailored sleep intervention for nurses whose role in public health is essential.

Insomnia Interventions in the Workplace: A Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis was to identify and evaluate the impact of interventions to improve or reduce insomnia in the workforce through randomized clinical trials. Following the recommendations of the PRISMA and MARS statement, a systematic literature search was carried out on the PubMed, Web of Science, CINHAL, and PsycINFO databases, with no restrictions on the language or publication date. For the meta-analysis, a random-effects model and the Insomnia Severity Index were used as outcome measures. To assess the risk of bias and the quality of evidence, the Cochrane Collaboration tool and the GRADE method were used, respectively. Twenty-two studies were included in the systematic review and 12 studies in the meta-analysis, making a total of 14 intervention groups with a sample of 827 workers. Cognitive behavioral therapy was the most widely used intervention. According to the estimated difference between the means, a moderate effect for the reduction of insomnia symptoms after the intervention (MD -2.08, CI 95%: [-2.68, -1.47]) and a non-significant degree of heterogeneity were obtained (p = 0.64; I² = 0%). The quality of the evidence and the risk of bias were moderate. The results suggest that interventions on insomnia in the workplace are effective for improving workers' health, and that improvements in the quality of sleep and a decrease in the symptoms of insomnia are produced, thanks to an increase in weekly sleeping hours and a reduction in latency at sleep onset. As regards work, they also led to improvements in productivity, presenteeism, and job burnout.

Work and sleep quality in railway employees: an actigraphy study

This actigraphy study tests whether daily work stressors (time pressure, social stressors), work resources (control, social support) and mental detachment from work predict sleep quality, when controlling for demands and control after work. Fifty-two railway employees participated during five consecutive workdays by completing diary questionnaires and wearing an actigraphy device. The results confirmed that social stressors from supervisors predicted more frequent sleep fragmentation and lower sleep efficiency the following night. Higher levels of daily time control at work predicted shorter sleep-onset latency and better self-reported sleep quality. Leisure time control as a covariate turned out to be a private resource, followed by fewer awakenings the following night. Detachment after work related negatively to social stressors and time pressure at work but was unrelated to indicators of sleep quality; detachment after work neither mediated nor moderated the relationship between social stressors from supervisors and sleep quality. Work redesign to increase time control and reduce social stressors is recommended to preserve daily recovery in railway employees. Practitioner summary: Sleep is important to renew health- and safety-related resources in railway employees. This diary and actigraphy study shows that higher daily work stressors were antecedents of lower sleep quality the following night, while more time control was followed by better sleep quality. Work redesign could promote health and safety by improving sleep quality.

Crossover of Resources and Well-Being within Employee-Partner Dyads: Through Increased Schedule Control

This study examined whether one partner's additional resources obtained from a workplace intervention influence the other partner's perception of having those resources at home (crossover of resources). We also examined whether one partner's decreased stress by increased work resources crosses over to the other partner's stress levels (crossover of well-being). Longitudinal data came from IT employees and their married/cohabiting partners in midlife (N=327). A randomized workplace intervention significantly increased employee-reported schedule control at the 6-month follow-up, which, in turn, increased partner-reported employees' work schedule flexibility to handle family responsibilities at the 12-month follow-up. The intervention also decreased partners' perceived stress at the 12-month follow-up through the processes by which increases in schedule control predicted decreases in employees' perceived stress, which further predicted decreased levels of partners' perceived stress. Notably, crossover of resources and well-being were found in couples who lived with children in the household, but not in couples without children. Our findings suggest that benefits of workplace support can permeate into the family domain, by increasing partner-perceived family resources and well-being.

What's not fair about work keeps me up: Perceived unfairness about work impairs sleep through negative work-to-family spillover

This study examined whether perceived unfairness about work was linked to midlife workers' insomnia symptoms over time, and if the association was mediated by negative work-to-family spillover (NWFS). We used 3 waves of longitudinal data across 20 years from the Midlife in the United States Study (N = 971, M_age = 40.52). Results revealed that, wave-to-wave increases in perceived unfairness about work predicted wave-to-wave increases in NWFS over 20 years. Wave-to-wave increases in NWFS, in turn, predicted wave-to-wave increases in insomnia symptoms. Perceived unfairness about work was indirectly, but not directly associated with insomnia symptoms through NWFS. These within-person indirect mediation pathways were found after controlling for sociodemographic and family characteristics, work hours, neuroticism, physical health, and between-person associations between perceived unfairness about work, NWFS, and insomnia symptoms. These findings suggest that perceived unfairness about work may degrade workers' sleep health over time, through the spillover of work stress to the personal domain.

Unpaid Caregiving Roles and Sleep Among Women Working in Nursing Homes: A Longitudinal Study

BACKGROUND AND OBJECTIVES

Although sleep is a critical health outcome providing insight into overall health, well-being, and role functioning, little is known about the sleep consequences of simultaneously occupying paid and unpaid caregiving roles. This study investigated the frequency with which women employed in U.S.-based nursing homes entered and exited unpaid caregiving roles for children (double-duty-child caregivers), adults (double-duty-elder caregivers), or both (triple-duty caregivers), as well as examined how combinations of and changes in these caregiving roles related to cross-sectional and longitudinal sleep patterns.

RESEARCH DESIGN AND METHODS

The sample comprised 1,135 women long-term care employees who participated in the baseline wave of the Work, Family, and Health Study and were assessed at three follow-up time points (6-, 12-, and 18-months). Sleep was assessed with items primarily adapted from the Pittsburgh Sleep Quality Index and wrist actigraphic recordings. Multilevel models with data nested within persons were applied.

RESULTS

Women long-term care employees entered and exited the unpaid elder caregiving role most frequently. At baseline, double-duty-child and triple-duty caregivers reported shorter sleep quantity and poorer sleep quality than their counterparts without unpaid caregiving roles, or workplace-only caregivers. Double-duty-elder caregivers also reported shorter sleep duration compared to workplace-only caregivers. Over time, double-duty-elder caregiving role entry was associated with negative changes in subjective sleep quantity and quality.

DISCUSSION AND IMPLICATIONS

Simultaneously occupying paid and unpaid caregiving roles has negative implications for subjective sleep characteristics. These results call for further research to advance understanding of double-and-triple-duty caregivers' sleep health and facilitate targeted intervention development.

Employee Sleep and Workplace Health Promotion: A Systematic Review

OBJECTIVE

Workplace-based employee health promotion programs often target weight loss or physical activity, yet there is growing attention to sleep as it affects employee health and performance. The goal of this review is to systematically examine workplace-based employee health interventions that measure sleep duration as an outcome.

DATA SOURCE

We conducted systematic searches in PubMed, Web of Knowledge, EMBASE, Scopus, and PsycINFO (n = 6177 records).

STUDY INCLUSION AND EXCLUSION CRITERIA

To be included in this systematic review, studies must include (1) individuals aged >18 years, (2) a worker health-related intervention, (3) an employee population, and (4) sleep duration as a primary or secondary outcome.

RESULTS

Twenty studies met criteria. Mean health promotion program duration was 2.0 months (standard deviation [SD] = 1.3), and mean follow-up was 5.6 months (SD = 6.5). The mean sample size of 395 employees (SD = 700.8) had a mean age of 41.5 years (SD = 5.2). Measures of sleep duration included self-report from a general questionnaire (n = 12, 66.6%), self-report based on Pittsburgh Sleep Quality Index (n = 4, 22.2%), and self-report and actigraphy combined (n = 5, 27.7%). Studies most commonly included sleep hygiene (35.0%), yoga (25.0%), physical activity (10.0%), and cognitive-behavioral therapy for insomnia (10.0%) interventions. Across the interventions, 9 different behavior change techniques (BCTs) were utilized; the majority of interventions used 3 or fewer BCTs, while 1 intervention utilized 4 BCTs. Study quality, on average, was 68.9% (SD = 11.1). Half of the studies found workplace-based health promotion program exposure was associated with a desired increase in mean nightly sleep duration (n = 10, 50.0%).

CONCLUSIONS

Our study findings suggest health promotion programs may be helpful for increasing employee sleep duration and subsequent daytime performance.

Psychosocial Workplace Factors and Healthcare Utilization: A Study of Two Employers

Background: While a large literature links psychosocial workplace factors with health and health behaviors, there is very little work connecting psychosocial workplace factors to healthcare utilization.

Methods: Survey data were collected from two different employers using computer-assisted telephone interviewing as a part of the Work-Family Health Network (2008-2013): one in the information technology (IT) service industry and one that is responsible for a network of long-term care (LTC) facilities. Participants were surveyed four times at six month intervals. Responses in each wave were used to predict utilization in the following wave. Four utilization measures were outcomes: having at least one emergency room (ER)/Urgent care, having at least one other healthcare visit, number of ER/urgent care visits, and number of other healthcare visits. Population-averaged models using all four waves controlled for health and other factors associated with utilization.

Results: Having above median job demands was positively related to the odds of at least one healthcare visit, odds ratio [OR] 1.37 (P<.01), and the number of healthcare visits, incidence rate ratio (IRR) 1.36 (P<.05), in the LTC sample. Work-to-family conflict was positively associated with the odds of at least one ER/urgent care visit in the LTC sample, OR 1.15 (P<.05), at least one healthcare visit in the IT sample, OR 1.35 (P<.01), and with more visits in the IT sample, IRR 1.35 (P<.01). Greater schedule control was associated with reductions in the number of ER/urgent care visits, IRR 0.71 (P<.05), in the IT sample.

Conclusion: Controlling for other factors, some psychosocial workplace factors were associated with future healthcare utilization. Additional research is needed.