Effects of Smartphone-Based Stress Management on Improving Work Engagement Among Nurses in Vietnam: Secondary Analysis of a Three-Arm Randomized Controlled Trial

[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.

Evaluation of the Association Between Sedentary Time and Low Work Engagement in the Work Environment After COVID-19 Pandemic: A Cross-Sectional Study of Japanese Workers

Introduction The global shift toward working from home due to the COVID-19 pandemic has led to concerns about increased sedentary behavior and its potential impact on work engagement, a critical factor for employee well-being and organizational productivity. This study aims to explore the association between sedentary time and work engagement among workers in Japan in the post-pandemic work environment. Methods This cross-sectional analysis utilized data from the Japan COVID-19 and Society Internet Survey (JACSIS), conducted from September to November 2023, after the COVID-19 pandemic period. Participants included employed individuals over 18 years, excluding those in domestic occupations. Sedentary time and work engagement were self-reported and categorized. Logistic regression analysis adjusted for confounders such as socioeconomic status, work characteristics, and mental and physical health was employed to explore this association. Results The study found a significant association between longer sedentary time and lower levels of work engagement. In particular, for desk workers, longer sedentary time was associated with lower work engagement (sedentary time, compared to the reference category "<4 hours/day", 4 to <8 h: OR 1.42, 95% CI: 1.25-1.60; 8 to <12 h: OR 1.77, 95% CI: 1.55-2.01; ≥12 h or unknown: OR 2.14, 95% CI: 1.80-2.51, respectively). Sensitivity analysis confirmed that these results are robust to different definitions of work engagement. Furthermore, analyses in subgroups of desk workers classified according to specific characteristics suggested that desk workers who are full-time workers in non-managerial positions and work from home ≥4 days per week were more strongly associated with prolonged sedentary behavior and low work engagement (in the group of full-time workers who were non-managers, sedentary time, compared to the reference category "<4 hours/day", 4 to <8 h: OR 2.14, 95% CI: 1.52-3.00; 8 to <12 h: OR 2.10, 95% CI: 1.46-3.00; ≥12 h or unknown: OR 3.32, 95% CI: 1.99-6.05; in those with work-from-home frequency of ≥4 days weekly, sedentary time, compared to the reference category "<4 hours/day", 4 to <8 h: OR 1.46, 95% CI: 0.99-2.16; 8 to <12 h: OR 1.73, 95% CI: 1.19-2.56; ≥12 h or unknown: OR 2.41, 95% CI: 1.58-3.67). Conclusions This study revealed a significant association between sedentary time and low work engagement among workers in Japan after the COVID-19 pandemic. In the future, prospective studies are needed to confirm the causal associations between the two, using more validated measures of sedentary behavior.

The use of mHealth apps to improve hospital nurses' mental health and well-being: A systematic review

BACKGROUND

Nursing well-being has become a heightened focus since the COVID-19 pandemic. Nurses are leaving the profession early in their careers or retiring sooner than expected. Those who remain in the workforce report higher levels of burnout, anxiety, depression, and exhaustion. There is concern that there may be a shortage of at least half a million nurses by 2030.

AIMS

This systematic review aimed to investigate the evidence of using a mental health promotion mHealth app to improve the mental health of hospital nurses.

METHODS

A systematic search was conducted in CINAHL Plus with Full Text, MEDLINE with Full Text, Professional Development Collection, Psychology and Behavioral Sciences Collection, Sociological Collection, PsycInfo, Embase, and PubMed with search dates of January 2012-November 15, 2022. The mHealth intervention needed to be asynchronously delivered through a smartphone with hospital nurse participants to be included in this review.

RESULTS

Of the 157 articles screened for this review, six were included. Primary outcome variables were anxiety, burnout, coping, depression, self-efficacy, stress, well-being, and work engagement. Intervention types included mindfulness-based interventions (MBIs), cognitive behavioral therapy (CBT), stress inoculation therapy (SIT), psychoeducation, and stress management. Anxiety, depression, well-being, and burnout improved with MBIs; depression improved with CBT; and anxiety and active coping improved with SIT.

LINKING EVIDENCE TO ACTION

This review demonstrated promising findings in using mHealth apps to improve the mental health of hospital nurses. However, more randomized controlled trials with larger sample sizes may reveal which type of mHealth app and how much exposure to the intervention is more effective in improving specific mental health symptoms. Longitudinal follow-up is also recommended to study sustainability of the mental health improvements.

The effectiveness of digital solutions in improving nurses' and healthcare professionals' mental well-being: a systematic review and meta-analysis

Background

Widespread challenges to mental well-being among nurses and healthcare professionals threaten the productivity and quality of healthcare. Digital solutions may prove to effectively support nurses' and healthcare professionals' mental well-being.

Aim

To synthesise evidence regarding the effectiveness of digital solutions in improving nurses' and healthcare professionals' mental well-being.

Methods

This systematic review followed the JBI guidance for systematic reviews of effectiveness. The PubMed, CINAHL, Scopus, Pro-Quest and APA PsycArticles databases were reviewed for randomised controlled trials and quasi-experimental studies published at any point prior to the 26th of October 2021. Meta-analysis and narrative synthesis were performed.

Results

Fourteen studies were included. Personal mental well-being solutions significantly improved nurses' and healthcare professionals' mental well-being. The effectiveness of work-related digital solutions could not be demonstrated. The meta-analysis revealed little to no effect on professionals' work engagement.

Conclusions

Personal digital solutions may have the potential to improve the mental well-being of nurses and healthcare professionals. With the support of nurse managers' facilitation, nurses have a key role to promote their own mental well-being by utilising digital mental health solutions. Nevertheless, further adequately powered, well-designed research is required.

Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review

Different interventions and methods are used for workplace health promotion (WHP) programmes, including mobile applications (apps), which have proven effective among different health outcomes if properly communicated and developed. However, knowledge is lacking on the potential advantages and disadvantages of using this technology for WHP compared with nontechnical WHP programmes to support employers in their decision making and effective development of such an intervention. To obtain an overview of factors that decision-makers should consider when deciding whether to implement an WHP app, we conducted a scoping review of studies that have evaluated WHP apps. Potential advantages and disadvantages of using mobile apps for WHP were summarised using a strengths, weaknesses, opportunities and threats (SWOT) analysis. Articles were included if they focussed on a WHP app, were published between 2007 and 2022 in German or English, and evaluated an app for the general employee population. Altogether, 38 studies were included in the review, demonstrating WHP apps' effectiveness among various use cases in terms of content, e.g., mindfulness or sleep, and target groups, e.g., office workers, nurses or pilots. Strengths were found in the context of adoption, convenience for users, the targeted employee group's reach and cost-effectiveness. However, the review also identified some disadvantages in apps, including technical difficulties and usage barriers, as well as challenges, e.g., privacy issues and maintenance costs. Generally, our review found that different factors need to be considered when deciding whether to implement a WHP app based on the individual company situation, e.g., shift work, content to be communicated, and expectations for health parameter screening, among many others. By summarising recent literature on WHP apps, this review uses scientific knowledge to give employers an overview of potential factors to consider in their decision making.

Factors Associated With Work Engagement of Nurses During the Fifth Wave of the COVID-19 Pandemic in Japan: Web-Based Cross-Sectional Study

BACKGROUND

The COVID-19 pandemic has brought to light the prevalence of mental health issues among nurses. Work engagement (WE) is a concept that describes work-related positive psychological states and is of importance within mental health measures. There is, however, a lack of research on factors associated with the WE of nurses during the COVID-19 pandemic.

OBJECTIVE

We aimed to determine which factors are associated with WE among nurses during the COVID-19 pandemic using the job demands-resources (JD-R) model as a framework.

METHODS

A web-based cross-sectional survey was conducted among nurses working in acute care and psychiatric institutions in the prefectures of Chiba and Tokyo in Japan. The survey period occurred between August 8 and September 30, 2021, during a time when the number of patients with a positive COVID-19 infection increased. The 3-item version of the Utrecht Work Engagement Scale (UWES-3) was used to measure WE. Factors such as age, gender, years of experience, affiliated ward, COVID-19-related stress, financial rewards from the government and hospital, encouragement from the government and patients, and workplace social capital were assessed. A total of 187 participants were included in the final analysis. Multiple regression analysis was performed to examine the factors related to WE. Partial regression coefficients (B), 95% CI, and P values were calculated.

RESULTS

The mean overall score for the UWES-3 was 3.19 (SD 1.21). Factors negatively associated with UWES-3 were COVID-19-related stress on work motivation and escape behavior (Β -0.16, 95% CI -0.24 to -0.090; P<.001), and factors positively associated with UWES-3 were affiliation of intensive care units (Β 0.76, 95% CI 0.020-1.50; P=.045) and financial rewards from the government and hospital (Β 0.40, 95% CI 0.040-0.76; P=.03).

CONCLUSIONS

This study examined factors related to WE among nurses during the COVID-19 pandemic using the JD-R model. When compared with findings from previous studies, our results suggest that nurses' WE was lower than before the COVID-19 pandemic. Negative motivation and escape behaviors related to COVID-19 were negatively associated with WE, while there were positive associations with financial rewards from the government and hospital and affiliation with an intensive care unit. Further research into larger populations is needed to confirm these findings.

Cognitive reappraisal in mHealth interventions to foster mental health in adults: a systematic review and meta-analysis

Background

An increasing number of mHealth interventions aim to contribute to mental healthcare of which interventions that foster cognitive reappraisal may be particularly effective.

Objectives

To evaluate the efficacy of mHealth interventions enhancing cognitive reappraisal to improve mental health in adult populations.

Methods

The literature search (four databases) yielded 30 eligible randomized controlled trials (comprising 3,904 participants). We performed a multi-level meta-analysis to examine differences between intervention and comparator conditions at post-intervention assessment. Moderator analyses were conducted for potential moderator variables (e.g., type of comparators).

Results

Most interventions were CBT-based with other training components in addition to cognitive reappraisal. We found preliminary evidence for a small to medium effect favouring mHealth interventions to enhance cognitive reappraisal over comparators, M(SMD) = 0.34, p = .002. When analysing single symptoms, there was evidence for a small to medium effect of mHealth interventions on anxiety and depressive symptoms, but not for psychological distress and well-being. All analyses showed substantial heterogeneity. Moderator analyses revealed evidence for more favourable effects in studies with passive comparators. There was an overall high risk of bias in most of the studies.

Conclusions

We found preliminary evidence for a small to medium effect of mHealth interventions including a cognitive reappraisal component to improve mental health. However, most of the interventions were complex (i.e., reappraisal was provided alongside other components), which prevents us from examining reappraisal-specific effects beyond general mental health promotion in mHealth. Dismantling studies examining the effects of single intervention components are warranted to corroborate these promising results.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=142149, identifier [CRD42019142149].

Effects of an Internet Delivered Behavioral Activation Program on Improving Work Engagement Among Japanese Workers: A Pretest and Posttest Study

OBJECTIVE

The aim of the study is to examine the effect of a newly developed Internet-delivered behavioral activation (iBA) program on work engagement and well-being among Japanese workers with elevated psychological distress.

METHODS

Participants were recruited via an Internet survey company ( N = 3299). The eligibility criteria were as follows: (1) Japanese employees aged 20 to 59 years, (2) having psychological distress, and (3) not self-employed. This iBA program was a 3-week web-based training course using behavioral activation techniques. Work engagement, psychological distress, and eudemonic well-being at work were measured at baseline and postintervention period. A paired sample t test was conducted to assess the intervention effect.

RESULTS

Of the 568 eligible participants, 120 were randomly selected. A total of 108 participants completed the baseline survey and received the iBA program. Eighty respondents completed the postintervention survey and were included in analyses. The iBA program did not show a significant intervention effect on work engagement ( P = 0.22, Cohen d = 0.14), while psychological distress ( P < 0.01, d = -0.40) and role-oriented future prospects ( P = 0.02, Cohen d = 0.27) were significantly improved.

CONCLUSIONS

The effect of the iBA program on work engagement may be limited.

Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials

Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review summarizes the findings of randomized controlled trials (RCTs) that examined the impact of different types of workplace interventions on various health indicators among health and social service workers. The review searched the PubMed database from its inception to December 2022 and included RCTs that reported on the effectiveness of organizational-level interventions and qualitative studies that explored barriers and facilitators to participation in such interventions. A total of 108 RCTs were included in the review, covering job burnout (N = 56 RCTs), happiness or job satisfaction (N = 35), sickness absence (N = 18), psychosocial work stressors (N = 14), well-being (N = 13), work ability (N = 12), job performance or work engagement (N = 12), perceived general health (N = 9), and occupational injuries (N = 3). The review found that several workplace interventions were effective in improving work ability, well-being, perceived general health, work performance, and job satisfaction and in reducing psychosocial stressors, burnout, and sickness absence among healthcare workers. However, the effects were generally modest and short-lived. Some of the common barriers to participation in workplace interventions among healthcare workers were inadequate staff, high workload, time pressures, work constraints, lack of manager support, scheduling health programs outside work hours, and lack of motivation. This review suggests that workplace interventions have small short-term positive effects on health and well-being of healthcare workers. Workplace interventions should be implemented as routine programs with free work hours to encourage participation or integrate intervention activities into daily work routines.

Individual-level interventions for reducing occupational stress in healthcare workers

BACKGROUND

Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions.  OBJECTIVES: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms.  SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms.  DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one's attention on the (modification of the) experience of stress (thoughts, feelings, behaviour);  2. focus one's attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise);  3. alter work-related risk factors on an individual level; and ones that 4. combine two or more of the above.  The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended).  MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised.  The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants.  Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention  Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention.  A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type  Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar.

AUTHORS' CONCLUSIONS

Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.

The efficacy of the internet-based stress recovery intervention FOREST for nurses amid the COVID-19 pandemic: A randomized controlled trial

BACKGROUND

The COVID-19 pandemic demanded exceptional physical and mental effort from healthcare workers worldwide. Since healthcare workers often refrain from seeking professional psychological support, internet-delivered interventions could serve as a viable alternative option.

OBJECTIVE

We aimed to investigate the effects of a therapist-guided six-week CBT-based internet-delivered stress recovery intervention among medical nurses using a randomized controlled trial design. We also aimed to assess program usability.

METHODS

168 nurses working in a healthcare setting (M_age = 42.12, SD_age = 11.38; 97 % female) were included in the study. The intervention group included 77 participants, and the waiting list control group had 91 participants. Self-report data were collected online at three timepoints: pre-test, post-test, and three-month follow-up. The primary outcome was stress recovery. Secondary outcomes included measures of perceived stress, anxiety and depression symptoms, psychological well-being, posttraumatic stress and complex posttraumatic stress symptoms, and moral injury.

RESULTS

We found that the stress recovery intervention FOREST improved stress recovery, including psychological detachment (d = 0.83 [0.52; 1.15]), relaxation (d = 0.93 [0.61, 1.25]), mastery (d = 0.64 [0.33; 0.95]), and control (d = 0.46 [0.15; 0.76]). The effects on psychological detachment, relaxation, and mastery remained stable at the three month follow-up. The intervention was also effective in reducing its users' stress (d = -0.49 [-0.80; -0.18]), anxiety symptoms (d = -0.31 [-0.62; -0.01]), depression symptoms (d = -0.49 [-0.80; -0.18]) and increasing psychological well-being (d = 0.53 [0.23; 0.84]) with the effects on perceived stress, depression symptoms, and well-being remaining stable at the three-month follow-up. High user satisfaction and good usability of the intervention were also reported.

CONCLUSIONS

The present study demonstrated that an internet-based intervention for healthcare staff could increase stress recovery skills, promote psychological well-being, and reduce stress, anxiety, and depression symptoms, with most of the effects being stable over three months.

TRIAL REGISTRATION

NCT04817995 (https://clinicaltrials.gov/ct2/show/NCT04817995). Registration date: March 30, 2021. Date of first recruitment: April 1, 2021.