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Longworth GR, de Boer J, Goh K, Agnello DM, McCaffrey L, Zapata Restrepo JR, An Q, Chastin S, Davis A, Altenburg T, Verloigne M, Giné-Garriga M. Navigating process evaluation in co-creation: a Health CASCADE scoping review of used frameworks and assessed components. BMJ Glob Health 2024; 9:e014483. [PMID: 38964878 PMCID: PMC11227756 DOI: 10.1136/bmjgh-2023-014483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/13/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Co-creation is seen as a way to ensure all relevant needs and perspectives are included and to increase its potential for beneficial effects and uptake process evaluation is crucial. However, existing process evaluation frameworks have been built on practices characterised by top-down developed and implemented interventions and may be limited in capturing essential elements of co-creation. This study aims to provide a review of studies planning and/or conducting a process evaluation of public health interventions adopting a co-creation approach and aims to derive assessed process evaluation components, used frameworks and insights into formative and/or participatory evaluation. METHODS We searched for studies on Scopus and the Health CASCADE Co-Creation Database. Co-authors performed a concept-mapping exercise to create a set of overarching dimensions for clustering the identified process evaluation components. RESULTS 54 studies were included. Conceptualisation of process evaluation included in studies concerned intervention implementation, outcome evaluation, mechanisms of impact, context and the co-creation process. 22 studies (40%) referenced ten existing process evaluation or evaluation frameworks and most referenced were the frameworks developed by Moore et al (14%), Saunders et al (5%), Steckler and Linnan (5%) and Nielsen and Randall (5%).38 process evaluation components were identified, with a focus on participation (48%), context (40%), the experience of co-creators (29%), impact (29%), satisfaction (25%) and fidelity (24%).13 studies (24%) conducted formative evaluation, 37 (68%) conducted summative evaluation and 2 studies (3%) conducted participatory evaluation. CONCLUSION The broad spectrum of process evaluation components addressed in co-creation studies, covering both the evaluation of the co-creation process and the intervention implementation, highlights the need for a process evaluation tailored to co-creation studies. This work provides an overview of process evaluation components, clustered in dimensions and reflections which researchers and practitioners can use to plan a process evaluation of a co-creation process and intervention.
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Affiliation(s)
| | - Janneke de Boer
- Department of Movement and Sports Sciences, Ghent University, Gent, Belgium
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Kunshan Goh
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Lauren McCaffrey
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Qingfan An
- Department of Community Medicine and Rehabilitation, Umeå University, Umea, Sweden
| | - Sebastien Chastin
- Department of Movement and Sports Sciences, Ghent University, Gent, Belgium
- Glasgow Caledonian University, Glasgow, UK
| | - Aaron Davis
- UniSA Creative, University of South Australia, Adelaide, South Australia, Australia
| | - Teatske Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Maite Verloigne
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Maria Giné-Garriga
- Faculty of Psychology, Education and Sport Sciences, Universitat Ramon Llull, Barcelona, Spain
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The effectiveness of organisational-level workplace mental health interventions on mental health and wellbeing in construction workers: A systematic review and recommended research agenda. PLoS One 2022; 17:e0277114. [DOI: 10.1371/journal.pone.0277114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives
This systematic review assesses the scientific evidence regarding the effectiveness of organisational-level workplace mental health interventions on stress, burnout, non-clinical depressive and anxiety symptoms, and wellbeing in construction workers.
Methods
Eligibility criteria were randomized controlled trials (RCTs), cluster randomized controlled trials (cRCTs), controlled or uncontrolled before- and after studies published in peer-reviewed journals between 2010 and May 2022 in five databases (Academic Search Complete, PsycInfo, PubMed, Scopus and Web of Science). Outcomes were stress, burnout and non-clinical depression and anxiety symptoms, and wellbeing (primary) and workplace changes and sickness absenteeism (secondary). Quality appraisal was conducted using the QATQS scale, a narrative synthesis was applied. The protocol was published in PROSPERO CRD42020183640 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020183640.
Main results
We identified five articles (four studies) with a total sample size of 260, one cRCT, one controlled before- and after study, and two uncontrolled before- and after studies. The methodological quality of one study was rated as moderate, while for three studies it was weak. One study showed significant effects of a work redesign programme in short-term physiological stress parameters, one study showed a significant employee perceived improvement of information flow after supervisor training and one study showed a substantial non-significant decline in sick leave. There was no significant effect on general mental health (SF12) nor on emotional exhaustion. The focus of all studies was on physical health, while detailed mental health and wellbeing measures were not applied.
Main conclusions
The evidence for the effectiveness of organisational-level workplace mental health interventions in construction workers is limited with opportunities for methodological and conceptual improvement. Recommendations include the use of a wider range of mental health and wellbeing outcomes, interventions tailored to the specific workplace and culture in construction and the application of the principles of complex interventions in design and evaluation.
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Cedstrand E, Augustsson H, Alderling M, Sánchez Martinez N, Bodin T, Nyberg A, Johansson G. Effects of a co-created occupational health intervention on stress and psychosocial working conditions within the construction industry: A controlled trial. Front Public Health 2022; 10:973890. [PMID: 36211695 PMCID: PMC9542354 DOI: 10.3389/fpubh.2022.973890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/31/2022] [Indexed: 01/21/2023] Open
Abstract
Background Work-related stress problems, i.e., burnout, depression, and anxiety, is a rising global health challenge. Poor mental health also appears to be a challenge for the construction industry, even though the occupational health focus has traditionally been on the physical work environment and musculoskeletal disorders. Yet, studies targeting the organisational level (i.e., work environment, policy) to enhance mental health within the construction industry are scant. Therefore, our first objective was to evaluate the effectiveness of a co-created occupational health intervention on stress and psychosocial working conditions within the construction industry in Sweden. The second objective was to evaluate whether the intervention was implemented as intended, i.e., implementation fidelity. The trial is registered in the ISRCTN clinical trial registry (ISRCTN16548039, http://isrctn.com/). Methods This is a controlled trial with one intervention and one matched control group. We co-created the program logic with stakeholders from the intervention group. The essence of the chosen intervention components, duties clarification, and structured roundmaking was enhanced planning and role clarification. We assessed adherence to the intervention and dose delivered (i.e., fidelity). We collected data on the outcomes (role clarity, team effectiveness, planning, staffing, quantitative demands, and the psychosocial safety climate) with online questionnaires at baseline, 12, and 24 months. Marginal means models adjusting for missing data patterns were applied to estimate potential differences in outcomes between groups over time. Results Fidelity was considered reasonably high. Yet, we found no intervention effects on the primary outcome stress. All outcomes, except role clarity deteriorated during the trial in the intervention and control group. However, the results indicate a positive effect of the intervention components on professionals' role clarity. The pandemic appears to have negatively affected stress and psychosocial working conditions. Conclusion The study's results suggest that co-creating occupational health interventions could be one solution for improved implementation fidelity. More studies are needed to evaluate these intervention components. Also, we recommend researchers of future intervention studies consider using missing not at random, sensitivity analysis.
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Affiliation(s)
- Emma Cedstrand
- Unit of Occupational Medicine, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,*Correspondence: Emma Cedstrand
| | - Hanna Augustsson
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Alderling
- Center of Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
| | | | - Theo Bodin
- Unit of Occupational Medicine, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Center of Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
| | - Anna Nyberg
- Unit of Occupational Medicine, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gun Johansson
- Unit of Occupational Medicine, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Center of Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
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Mann F, Wang J, Pearce E, Ma R, Schlief M, Lloyd-Evans B, Ikhtabi S, Johnson S. Loneliness and the onset of new mental health problems in the general population. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2161-2178. [PMID: 35583561 PMCID: PMC9636084 DOI: 10.1007/s00127-022-02261-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 02/18/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Loneliness is associated with poor health including premature mortality. There are cross-sectional associations with depression, anxiety, psychosis, and other mental health outcomes. However, it is not known whether loneliness is causally linked with the new onset of mental health problems in the general population. Longitudinal studies are key to understanding this relationship. We synthesized evidence from longitudinal studies investigating the relationship between loneliness and new onset of mental health problems, in the general population. METHOD We systematically searched six electronic databases, unpublished sources, and hand-searched references, up to August 2021. We conducted a meta-analysis of eight independent cohorts and narrative synthesis of the remaining studies. RESULTS We included 32 studies, of which the majority focused on depression. Our narrative synthesis found most studies show loneliness at baseline which is associated with the subsequent new onset of depression. The few studies on anxiety and self-harm also showed a positive association. Our meta-analysis found a pooled adjusted odds ratio of 2.33 (95% CI 1.62-3.34) for risk of new onset depression in adults who were often lonely compared with people who were not often lonely. This should be interpreted with caution given evidence of heterogeneity. CONCLUSION Loneliness is a public mental health issue. There is growing evidence it is associated with the onset of depression and other common mental health problems. Future studies should explore its impact across the age range and in more diverse populations, look beyond depression, and explore the mechanisms involved with a view to better informing appropriate interventions.
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Affiliation(s)
- Farhana Mann
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Jingyi Wang
- School of Public Health Shanghai, Fudan University, Shanghai, China
| | - Eiluned Pearce
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Ruimin Ma
- Department of Psychological Medicine, Kings College London, London, UK
| | - Merle Schlief
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sarah Ikhtabi
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, Wing B, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
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Cedstrand E, Mølsted Alvesson H, Augustsson H, Bodin T, Bodin E, Nyberg A, Johansson G. Co-Creating an Occupational Health Intervention within the Construction Industry in Sweden: Stakeholder Perceptions of the Process and Output. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412872. [PMID: 34948487 PMCID: PMC8700815 DOI: 10.3390/ijerph182412872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
One way to prevent work-related stress, is to implement primary occupational health interventions aimed at improving the psychosocial work environment. However, such interventions have shown a limited effect, often due to implementation failure and poor contextual fit. Co-creation, where researchers, together with end-users and other relevant stakeholders, develop the intervention is increasingly encouraged. However, few studies have evaluated the effects of co-created interventions, and participants’ experience of the co-creation process. This is one of the first studies evaluating stakeholder perceptions of co-creating an occupational health intervention. We applied a thematic analysis, with data from 12 semi-structured interviews with stakeholders involved in the co-creation. Our results show that the respondents, in general, were satisfied with engaging in the co-creation, and they reported an increased awareness regarding risk factors of stress and how these should be handled. Additionally, the respondents described trust in the intervention activities and a good fit into the context. The study indicates that co-creating occupational health interventions can enhance the implementation and the contextual fit.
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Affiliation(s)
- Emma Cedstrand
- Unit of Occupational Medicine, Institute for Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (T.B.); (E.B.); (A.N.); (G.J.)
- Correspondence:
| | | | - Hanna Augustsson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Theo Bodin
- Unit of Occupational Medicine, Institute for Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (T.B.); (E.B.); (A.N.); (G.J.)
- Center of Occupational and Environmental Medicine, Stockholm Region, 113 65 Stockholm, Sweden
| | - Erika Bodin
- Unit of Occupational Medicine, Institute for Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (T.B.); (E.B.); (A.N.); (G.J.)
| | - Anna Nyberg
- Unit of Occupational Medicine, Institute for Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (T.B.); (E.B.); (A.N.); (G.J.)
- Department of Public Health and Caring Sciences, Uppsala University, 751 22 Uppsala, Sweden
| | - Gun Johansson
- Unit of Occupational Medicine, Institute for Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (T.B.); (E.B.); (A.N.); (G.J.)
- Center of Occupational and Environmental Medicine, Stockholm Region, 113 65 Stockholm, Sweden
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Cedstrand E, Nyberg A, Sanchez-Bengtsson S, Alderling M, Augustsson H, Bodin T, Mölsted Alvesson H, Johansson G. A Participatory Intervention to Improve the Psychosocial Work Environment and Mental Health in Human Service Organisations. A Mixed Methods Evaluation Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073546. [PMID: 33805501 PMCID: PMC8037176 DOI: 10.3390/ijerph18073546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022]
Abstract
Work-related stress is a global problem causing suffering and economic costs. In Sweden, employees in human service occupations are overrepresented among persons on sick leave due to mental health problems such as stress-related disorders. The psychosocial work environment is one contributing factor for this problem, making it urgent to identify effective methods to decrease stress at the workplace. The aim of the study is to evaluate a participatory intervention to improve the psychosocial work environment and mental health using an embedded mixed methods design. The study is a controlled trial with a parallel process evaluation exploring fidelity and participants’ reactions to the intervention activities, experiences of learning and changes in behaviours and work routines. We collected data through documentation, interviews and three waves of questionnaires. Our results show small changes in behaviours and work routines and no positive effects of the intervention on the psychosocial work environment nor health outcomes. One explanation is end-users’ perceived lack of involvement over the process causing the intervention to be seen as a burden. Another explanation is that the intervention activities were perceived targeting the wrong organisational level. A representative participation over both content and process can be an effective strategy to change psychosocial working conditions and mental health.
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Affiliation(s)
- Emma Cedstrand
- Institute for Environmental Medicine, Karolinska Institutet, Unit of Occupational Medicine, 171 77 Stockholm, Sweden; (A.N.); (M.A.); (T.B.); (G.J.)
- Correspondence:
| | - Anna Nyberg
- Institute for Environmental Medicine, Karolinska Institutet, Unit of Occupational Medicine, 171 77 Stockholm, Sweden; (A.N.); (M.A.); (T.B.); (G.J.)
- Department of Public Health and Caring Sciences, Uppsala University, 751 22 Uppsala, Sweden
| | - Sara Sanchez-Bengtsson
- Center of Occupational and Environmental Medicine, Stockholm Region, 113 65 Stockholm, Sweden;
| | - Magnus Alderling
- Institute for Environmental Medicine, Karolinska Institutet, Unit of Occupational Medicine, 171 77 Stockholm, Sweden; (A.N.); (M.A.); (T.B.); (G.J.)
- Center of Occupational and Environmental Medicine, Stockholm Region, 113 65 Stockholm, Sweden;
| | - Hanna Augustsson
- Medical Management Centre, Procome Research Group, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Theo Bodin
- Institute for Environmental Medicine, Karolinska Institutet, Unit of Occupational Medicine, 171 77 Stockholm, Sweden; (A.N.); (M.A.); (T.B.); (G.J.)
- Center of Occupational and Environmental Medicine, Stockholm Region, 113 65 Stockholm, Sweden;
| | | | - Gun Johansson
- Institute for Environmental Medicine, Karolinska Institutet, Unit of Occupational Medicine, 171 77 Stockholm, Sweden; (A.N.); (M.A.); (T.B.); (G.J.)
- Center of Occupational and Environmental Medicine, Stockholm Region, 113 65 Stockholm, Sweden;
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