A Cluster Randomized Controlled Trial to Evaluate HeadCoach: An Online Mental Health Training Program for Workplace Managers

[On the Effectiveness of Digital Workplace Health Promotion in Times of Home Office: A Systematic Review]

BACKGROUND

In the face of an increasingly aging, multimorbid, chronically ill workforce, company health promotion (BGF) is an important instrument for promoting and maintaining the health of employees in the workplace. Due to digitization and the increasing possibilities of working from home, digital offers for workplace health promotion (dBGF) are being used increasingly in organizations. The portfolio of offers ranges from fitness trackers, online platforms, and health apps to so-called wearables, so that a broad, individual selection is possible for both organizations and employees.

THE AIM OF THE STUDY

The aim of the study was to identify and analyze randomized controlled trials (RCT) with regard to the health-promoting effectiveness of dBGF.

MATERIAL AND METHODS

A systematic literature search was carried out in relevant specialist databases (PubMed, Livivo, Cochrane Library). The identified studies were selected, evaluated and then descriptively presented by several people systematically and independently.

RESULTS

17 relevant contributions could be identified and analyzed. Above all, measures to promote physical activity and programs to improve mental health were identified in the RCT studies that were carried out. The results of the studies carried out indicate that dBGF can promote health in a variety of ways and support organizations in providing a health-promoting working environment.

DISCUSSION

The effectiveness of dBGF could be proven on the basis of the studies identified, whereby the effects are undoubtedly influenced and determined by the employees, above all by their health competence. In order to ensure the long-term effectiveness of dBGF, it will be necessary in the future to increase the interest and motivation of employees with regard to personal health promotion and illness prevention.

Typology of employers offering line manager training for mental health

BACKGROUND

Mental ill health has a high economic impact on society and employers. National and international policy advocates line manager (LM) training in mental health as a key intervention, but little is known about employer training provisions.

AIMS

To explore the prevalence and characteristics of organizations that offer LM training in mental health.

METHODS

Secondary analysis of existing longitudinal anonymised organizational-level survey data derived from computer-assisted telephone interview surveys collected in four waves (2020:1900 firms, 2021:1551, 2022:1904, 2023:1902) in England, before, during and after a global pandemic.

RESULTS

The proportion of organizations offering LM training in mental health increased pre- to post-pandemic (2020:50%, 2023:59%) but 41% do not currently provide it. Logistic regression confirmed that LM training is more likely to be offered by large-sized enterprises, organizations with a larger proportion of employees who are younger (aged 25-49), female, disabled and from ethnic minority communities. Sector patterns were inconsistent, but in 2023, organizations from the 'Hospitality' and 'Business Services' sectors were more likely to provide LM training than other sectors.

CONCLUSIONS

Continued efforts are needed to increase the proportion of employers offering LM training in mental health, particularly small- to medium-sized enterprises, and organizations with predominantly male, White and/or older workforces.

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.

Workplace mental health screening: a systematic review and meta-analysis

Workplaces are an important location for population mental health interventions. Screening to detect employees at risk of or experiencing mental ill health is increasingly common. This systematic review and meta-analysis examined the efficacy of workplace mental health screening programmes on employee mental health, work outcomes, user satisfaction, positive mental health, quality of life, help-seeking and adverse effects. PubMed, PsycINFO, EMBASE, CENTRAL, Global Index Medicus, Global Health and SciELO were searched (database inception-10 November 2022) and results screened by two independent reviewers. Controlled trials evaluating screening of workers' mental health as related to their employment were included. Random effects meta-analysis was performed to calculate pooled effect sizes for each outcome of interest. Grading of Recommendations Assessment, Development and Evaluation was conducted to evaluate the certainty of findings. Of the 12 328 records screened, 11 were included. These reported 8 independent trials collectively assessing 2940 employees. Results indicated screening followed by advice or referral was ineffective in improving employee mental health symptoms (n=3; d=-0.07 (95% CI -0.29 to 0.15)). Screening followed by facilitated access to treatment interventions demonstrated a small improvement in mental health (n=4; d=-0.22 (95% CI -0.42 to -0.02)). Limited effects were observed for other outcomes. Certainty ranged from low to very low. The evidence supporting workplace mental health screening programmes is limited and available data suggest mental health screening alone does not improve worker mental health. Substantial variation in the implementation of screening was observed. Further research disentangling the independent effect of screening alongside the efficacy of other interventions to prevent mental ill health at work is required.

Effectiveness of a support program for balancing treatment and work in small and medium-sized enterprises promoted by occupational health nurses using a web meeting system: A cluster randomized controlled trial

OBJECTIVES

In this study, we conducted a cluster randomized control trial to verify the effectiveness of a treatment work balance support (TWBS) program promoted by occupational health nurses (OHNs) in small and medium-sized enterprises (SMEs) using a web meeting system.

METHODS

We analyzed data from 64 managers (32 each in the control and intervention groups) and 541 workers (246 and 295 in the control and intervention groups, respectively) from 22 SMEs (11 in each group) with less than 200 workers. The TWBS program comprised online consultations for managers and seminars for workers by an OHN. TWBS leaflets were distributed among both groups. The "Recognition and Attitude Scale toward TWBS" was administered and workplace climate, psychological safety (PS), and work engagement (WE) scores were measured at baseline and endpoint. The increase in scores of each group was analyzed using a linear mixed-effects model.

RESULTS

Increases in managers' scores on all three recognition and attitude subscales were significantly greater in the intervention than in the control group (P = .048, .003, and .032, respectively). Workers' score increases were significantly higher on two subscales-recognition of workplace initiatives and understanding of professionals' roles-in the intervention than in the control group (P = .043 and .001, respectively). There was no difference between the two groups in the amount of increase in PS and WE, as perceived by managers and workers.

CONCLUSIONS

The TWBS program by OHNs increased recognition and attitude among SME managers and workers, indicating the usability of promoting TWBS in SMEs.

Preconception Health in the Workplace: An Opportunity to Support Equitable Access to Education

Preconception health is a key determinant of pregnancy and offspring outcomes, but challenges reaching people during preconception are frequently cited by health professionals. This article highlights the workplace as an important setting for promoting equitable access to preconception health-related information and education to support optimal well-being before pregnancy. Workplaces can support equitable access to education and knowledge for preconception health: (1) due to the high engagement of reproductive-age women in the workforce and (2) by reaching vulnerable or high-risk population groups who may otherwise face barriers to accessing preconception health information. Literature that explicitly investigates workplace delivery of preconception health promotion programs is scarce. However, workplace health promotion more broadly is associated with improved corporate competitiveness, productivity, and strengthened employee-employer relationships. Workplace health promotion activities may also address social determinants of health and improve employee well-being outcomes. The opportunity for workplaces to benefit from an increase in the bottom line makes workplace health promotion programs more attractive, but organizational support and stakeholder engagement are needed to facilitate the design and delivery of successful workplace preconception health education programs. Such programs have the potential to facilitate health gains for women and their families.

Managing Minds at Work: Development of a Digital Line Manager Training Program

Mental ill-health is the leading cause of sickness absence, creating a high economic burden. Workplace interventions aimed at supporting employers in the prevention of mental ill-health in the workforce are urgently required. Managing Minds at Work is a digital intervention aimed at supporting line managers in promoting better mental health at work through a preventative approach. This intervention was developed as part of the Mental Health and Productivity Pilot, a wider initiative aimed at supporting employers across the Midlands region of the United Kingdom to improve the future of workplace mental health and wellbeing. The aim of the study is to describe the design and development of the Managing Minds at Work digital training program, prior to feasibility testing. We adopted a collaborative participatory design involving co-design (users as partners) and principles of user-centred design (pilot and usability testing). An agile methodology was used to co-create intervention content with a stakeholder virtual community of practice. Development processes were mapped to core elements of the Medical Research Council (MRC) framework for developing and evaluating complex interventions. The program covers five broad areas: (i) promoting self-care techniques among line managers; (ii) designing work to prevent work-related stress; (iii) management competencies to prevent and reduce stress; (iv) having conversations with employees about mental health; (v) building a psychologically safe work environment. It was considered by stakeholders to be appropriate for any type of organization, irrespective of their size or resources. Pilot and usability testing (n = 37 surveys) aligned with the Technology Acceptance Model (TAM) demonstrated that the program was perceived to be useful, relevant, and easy to use by managers across sectors, organization types, and sizes. We identified positive impacts on manager attitudes and behavioral intentions related to preventing mental ill-health and promoting good mental wellbeing at work. The next step is to explore the feasibility and acceptability of Managing Minds at Work with line managers in diverse employment settings.

Examining the Preliminary Effectiveness and Acceptability of a Web-Based Training Program for Australian Secondary School Teachers: Pilot Study of the BEAM (Building Educators' Skills in Adolescent Mental Health) Program

BACKGROUND

Secondary schools are increasingly supporting adolescents' mental health and well-being, yet many teachers report that they lack the skills and confidence to do so. Building Educators' skills in Adolescent Mental Health (BEAM) is a web-based training program developed to improve secondary school teachers' knowledge and confidence in caring for students' mental health.

OBJECTIVE

This pilot study examined the preliminary effectiveness and acceptability of the BEAM program for improving mental health knowledge, attitudes, confidence, helping behaviors, and psychological distress among secondary school teachers.

METHODS

A single-arm pilot trial was conducted from July to December 2019 among secondary school teachers located in New South Wales, Australia, who were employed in leadership positions responsible for managing student well-being (ie, Year Advisors). Participants had access to the BEAM program for 6 weeks. Self-report surveys, delivered at baseline, postintervention (6-weeks post baseline) and 3-month follow-up (19 weeks post baseline) were used to measure changes in training outcomes. Acceptability was assessed by program use, barriers, satisfaction, and participants' perceptions of program effectiveness.

RESULTS

A total of 70 secondary school teachers took part (mean age 36.5 years, SD 9.41 years, range 24-60 years). Significant improvements in confidence were reported at postintervention and 3-month follow-up. Significant improvements in helping behaviors were reported at 3-month follow-up only. There was also a significant reduction in psychological distress at postintervention. Participants agreed that the program content was easy to understand and relevant, but program completion was challenged by lack of time, competing priorities, and forgetfulness.

CONCLUSIONS

Findings indicated that a web-based training program may be beneficial for improving secondary school teachers' abilities to care for students' mental health; however, program modifications are required to increase training completions.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000821190, Universal Trial Number U1111-1232-7680; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377529.

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.

Développement et tests utilisateurs de l’application Web PRATICAdr : Plateforme de Retour Au Travail axée sur les Interactions et la Communication entre les Acteurs, intégrant un programme Durable favorisant le Rétablissement

Introduction Les troubles mentaux courants (TMC) représentent de 30 % à 50 % des absences maladies toutes confondues. Le succès du retour au travail (RAT) n’est pas dû au seul fait de l’individu, mais plutôt au résultat de l’interaction entre les acteurs impliqués dans le processus. De nombreuses applications en santé mentale ont été développées pour améliorer la prise en charge des patients et optimiser la communication entre les professionnels, sans toutefois être validées. De plus, aucune solution technologique n’a été développée à ce jour pour faciliter à la fois la concertation des acteurs du RAT (p. ex. gestionnaire, professionnels de la santé) et l’accompagnement systématique de l’employé dans son RAT.

Objectif Pour combler ces lacunes, l’objectif de cet article est double : 1) décrire le développement de l’application PRATICAdr, Plateforme de Retour Au Travail axée sur les Interactions et la Communication entre les Acteurs : un programme Durable favorisant le Rétablissement ; 2) documenter les tests utilisateurs de l’application PRATICAdr.

Méthode Le développement de PRATICAdr se décline en 3 phases : 1) l’analyse des besoins ; 2) la conceptualisation des mécanismes internes à l’application et des techniques de programmation ; 3) le test de l’application en situation réelle. L’application est évaluée par des questionnaires et entrevues pour mesurer la satisfaction des utilisateurs.

Résultats PRATICAdr permet de suivre en temps réel le parcours des acteurs impliqués dans l’accompagnement personnalisé de l’employé dans son RAT. La schématisation du processus de RAT et l’inclusion d’outils d’évaluation validés systématisent la concertation et la prise de décision partagée des acteurs, ainsi que le suivi et les actions posées en vue d’entreprendre un RAT favorisant le rétablissement. L’interface de PRATICAdr a été développée pour simplifier l’expérience utilisateur de l’employé en absence maladie et des acteurs du RAT. Les résultats de satisfaction des premiers utilisateurs de PRATICAdr, 16 employés d’une grande organisation dans le domaine de la santé en processus de RAT à la suite d’un TMC, apprécient (moyenne > 9/10) non seulement la Plateforme Web, mais également la participation des acteurs du RAT et les questionnaires inclus dans PRATICAdr. Des éléments d’amélioration sont aussi proposés.

Conclusion PRATICAdr est implantée dans 2 grandes organisations (> 15 000 employés) afin d’évaluer son efficacité auprès d’employés en absence maladie en raison d’un TMC et en processus de RAT. Dans le cadre de cet article, l’objectif était de présenter non seulement le développement de PRATICAdr, mais aussi de mesurer la satisfaction des utilisateurs. Les premiers résultats indiquent une appréciation élevée chez les employés en absence maladie, utilisateurs de PRATICAdr. En termes de pistes futures, l’intégration de l’apprentissage automatique sera abordée dans l’objectif de personnaliser le programme de RAT selon les prédictions de durée d’absence maladie et de RAT durable.

The Building Educators' Skills in Adolescent Mental Health Training Program for Secondary School Educators: Protocol for a Cluster Randomized Controlled Trial

Background

In Australia, secondary school educators are well positioned to recognize mental illness among students and provide support. However, many report that they lack the knowledge and confidence to do so, and few mental health training programs available for educators are evidence based. To address this gap, the Black Dog Institute (BDI) developed a web-based training program (Building Educators’ Skills in Adolescent Mental Health [BEAM]) that aims to improve mental health knowledge, confidence, and helping behaviors among secondary school educators in leadership positions. A pilot study of the training program found it to be positively associated with increased confidence and helping behaviors among educators and reduced personal psychological distress. An adequately powered randomized controlled trial (RCT) is needed.

Objective

The primary objective of this cluster RCT is to evaluate the effectiveness of the BEAM program for improving educators’ confidence in managing student mental health. The trial will also evaluate the effect of the BEAM program in increasing educators’ frequency of providing help to students and improving their mental health knowledge and reducing educators’ psychological distress and stigma toward students with mental health issues.

Methods

The target sample size is 234 educators from 47 secondary schools across New South Wales, Australia. Four waves of recruitment and enrollment into the trial are planned. Schools will participate in one wave only and will be randomized to the intervention or waitlist control conditions. Participants from the same school will be assigned to the same condition. Assessments will be conducted at baseline, posttest (10 weeks after baseline), and follow-up (22 weeks after baseline) using the BDI eHealth research platform. Intervention participants will receive access to the BEAM program for 10 weeks upon completion of baseline, and the control condition will receive access for 10 weeks upon completion of the follow-up assessment.

Results

Recruitment for this trial began on July 21, 2020, with the first baseline assessments occurring on August 17, 2020. To date, 295 participants from 71 schools have completed baseline. Due to the unexpected success of recruitment in the first 3 waves, the final fourth wave has been abandoned. Intervention participants are currently receiving the program, with follow-up due for completion in March 2021.

Conclusions

This is one of the first RCTs to examine the effectiveness of a web-based adolescent mental health training program for Australian secondary school educators in leadership positions. If found to be effective, this training program will offer a sustainable and scalable delivery method for upskilling educators in caring for students’ mental health.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12620000876998; https://covid-19.cochrane.org/studies/crs-14669208

International Registered Report Identifier (IRRID)

DERR1-10.2196/25870

Can an online mental health training program improve physician supervisors' behaviour towards trainees?

BACKGROUND

Physician trainees have elevated rates of psychological distress, mental disorders and suicide. Physician supervisors can support the mental health needs of trainees.

AIM

To test the feasibility and acceptability of a tailored online mental health training program and ascertain the potential effectiveness of the program to alter the confidence and behaviours of physician supervisors.

METHODS

Thirty Australian hospital-based physicians who were supervising physician trainees, participated in this quasi-experimental pre-post pilot study. All received the intervention which comprised twelve 5-minute modules to complete over a 3-week period. Baseline and post-intervention data were collected. The primary outcome evaluated participants' confidence to respond to trainees experiencing mental ill-health and promote a mentally healthy workplace. Secondary outcomes evaluated change in self-reported behaviour, mental health knowledge and stigmatising attitudes. Differences in mean scale scores for each outcome measure from baseline and post-intervention were compared using paired sample t-tests.

RESULTS

Thirty physicians completed the baseline assessment, and 23 (76.7%) completed all program modules. Most participants found the program engaging, interesting and useful. Post-intervention data, available for 25 (83.3%) participants, showed a significant increase in participants' knowledge of their role in supporting trainees under their supervision (p=0.002), confidence to initiate conversations about mental health with staff (p<0.001), and application of preventive and responsive supervisory behaviours to support the mental health needs of those they supervise (p<0.001).

CONCLUSIONS

This online mental health training program for physician supervisors was feasible and associated with improved confidence and behaviour to support the mental health needs of trainees they supervised. This article is protected by copyright. All rights reserved.

Pre-incident Training to Build Resilience in First Responders: Recommendations on What to and What Not to Do

Emergency services are under enormous pressure to offer programmes that could protect their staff from the psychological impact of stressors encountered in their roles. There has been a surge in the number of pre-incident training programmes aimed at first responders to maintain their psychological wellbeing after critical incidents. These include pre-employment screening programmes, psychoeducation, operational training, line manager training and interventions aimed at improving resilience, wellbeing or stress management. Whilst developed with the best intentions, these programmes vary in efficacy. Therefore, knowing what training to offer first responders prior to exposure to critical incidents is far from clear. In this review, we critique the available evidence and make recommendations about what to offer and what to avoid offering first responders prior to exposure to critical incidents. We found no evidence of the effectiveness of pre-employment screening or psychoeducation offered as a standalone package, and little evidence for interventions aimed to improve wellbeing and resilience to stress - although current trials of empirically-driven interventions for first responders are underway and show promise in preventing stress-related psychopathology. Operational and line manager training showed the most promise but need to be evaluated in high quality trials with sufficient follow-up to draw conclusions about their preventative benefits.

A comparison of face-to-face and online training in improving managers' confidence to support the mental health of workers

BACKGROUND

In recognition of the important role managers play in the well-being of the staff they supervise, many workplaces are implementing specialised training for leaders to help them better understand and support the mental health needs of their staff. This training can be delivered through face-to-face or online training sessions. Evaluation of such programs have found positive results for each format when compared to a control group, but to date, face-to-face and online manager mental health training have not been compared with one another.

AIMS

This study brings together results from two trials evaluating the same program content, each employing a different mode of content delivery. Both types of training aimed to change managers' confidence to better support the mental health needs of the staff they supervise.

METHODS

Utilising data derived from two previously conducted trials, mean change in manager confidence from baseline at both post-intervention and follow-up were examined for each method of content delivery. An identical way of measuring confidence was used in each study.

RESULTS

Managers' confidence improved from baseline with both methods of training. A greater change was observed with face-to-face training than for online, although both methods had sustained improvement over time. Analyses indicate that at follow-up, improvements in confidence were significant for both face-to-face (t ₁₈  = 5.99; P < .001) and online training (t ₃₉  = 3.85; P < .001). Analyses focused on managers who fully completed either type of training indicated very similar impacts for face-to-face and online training.

CONCLUSIONS

Both face-to-face and online delivery of manager mental health training can significantly improve managers' confidence in supporting the mental health needs of their staff. This change is sustained over various follow-up periods. However, lower retention rates common in online training reduce the relative effect of this method of delivery.