1
|
Engels M, Scheepers L, Engels J, Boß L, Kuhlmann R, Kuske J, Lesener L, Pavlista V, Schmidt-Stiedenroth K, Diebig M, Ruhle SA, Zapkau FB, Angerer P, Hoewner J, Lehr D, Schwens C, Süß S, Wulf IC, Dragano N. Web-based occupational stress prevention in German micro- and small-sized enterprises - process evaluation results of an implementation study. BMC Public Health 2024; 24:1618. [PMID: 38886711 PMCID: PMC11184923 DOI: 10.1186/s12889-024-19102-8] [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: 11/20/2023] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Structural and behavioral interventions to manage work-related stress are effective in employees. Nonetheless, they have been implemented insufficiently, particularly in micro- and small-sized enterprises (MSE). Main barriers include a lack of knowledge and limited resources, which could potentially be overcome with simplified web-based alternatives for occupational stress prevention. However, there is a lack of implementation research about web-based prevention in realistic settings of MSE. OBJECTIVE The aim of this study is to evaluate the implementation process and success of an integrated web-based platform for occupational stress prevention ("System P") and to identify potential barriers for its uptake and use in MSE in Germany. METHODS This study with a mixed-methods approach investigates eight process-related outcomes in a quantitative part I (adoption, reach, penetration, fidelity/dose, costs, acceptability) and a qualitative part II (acceptability, appropriateness and feasibility). Part I has a pre-post design with two measurements (6 months apart) with 98 individual participants and part II consists of 12 semi-structured interviews with managers and intercorporate stakeholders. RESULTS Part I revealed shortcomings in the implementation process. Adoption/Reach: Despite extensive marketing efforts, less than 1% of the contacted MSE responded to the offer of System P. A total of 40 MSE registered, 24 of which, characterized by good psychosocial safety climate, adopted System P. Penetration: Within these 24 MSE, 15% of the employees used the system. Fidelity/Dose: 11 MSE started a psychosocial risk-assessment (PRA), and no MSE finished it. The stress-management training (SMT) was started by 25 users and completed by 8. COSTS The use of System P was free of charge, but the time required to engage with was an indirect cost. Part II added insights on the perception of the web-based intervention: Acceptance of System P by users and stakeholders was good and it was assessed as appropriate for MSE. Results for feasibility were mixed. CONCLUSIONS Although System P was generally perceived as useful and appropriate, only a small number of contacted MSE implemented it as intended. Prior experience and sensitivity for occupational (stress) prevention were mentioned as key facilitators, while (perceived) indirect costs were a key barrier. Enabling MSE to independently manage stress prevention online did not result in successful implementation. Increasing external support could be a solution. ⁺ FULL PROJECT NAME: "PragmatiKK - Pragmatische Lösungen für die Implementation von Maßnahmen zur Stressprävention in Kleinst- und Kleinbetrieben" (= Pragmatic solutions for the implementation of stress prevention interventions in micro and small-sized enterprises). TRIAL REGISTRATION German Register of Clinical Studies (DRKS) DRKS00026154, date of registration 2021-09-16.
Collapse
Affiliation(s)
- Miriam Engels
- Department of Work and Organisational Psychology, Faculty of Psychology, Open University of the Netherlands, Valkenburgerweg 177, Heerlen, 6419 AT, The Netherlands
| | - Louisa Scheepers
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Judith Engels
- Department of Work and Organisational Psychology, Faculty of Psychology, Open University of the Netherlands, Valkenburgerweg 177, Heerlen, 6419 AT, The Netherlands
- Chair of Business Administration, in particular Work, Human Resource Management and Organization Studies, Faculty of Business Administration and Economics, Heinrich-Heine-University Dusseldorf, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | - Leif Boß
- Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Luneburg, Universitätsallee 1, 21335, Lüneburg, Germany
| | - Rebekka Kuhlmann
- Chair of Business Administration, in particular Work, Human Resource Management and Organization Studies, Faculty of Business Administration and Economics, Heinrich-Heine-University Dusseldorf, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | - Johanna Kuske
- Chair for Entrepreneurship and Management, Faculty of Management, Economics and Social Sciences, University of Cologne, Albertus‑Magnus‑Platz, 50923, Köln, Germany
| | - Lutz Lesener
- K12 Agentur für Kommunikation und Innovation GmbH, Schirmerstr. 76, 40211, Düsseldorf, Germany
| | - Valeria Pavlista
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Kira Schmidt-Stiedenroth
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Mathias Diebig
- Department of Work and Organisational Psychology, Faculty I - Psychology, Trier University, Universitätsring 15, 54296, Trier, Germany
| | - Sascha A Ruhle
- Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Luneburg, Universitätsallee 1, 21335, Lüneburg, Germany
- Department of Human Resource Studies, Tilburg University, Prof. Cobbenhagenlaan 225, Tilburg, 5037 DB, The Netherlands
| | - Florian B Zapkau
- Institute for International Business, Department of Global Business and Trade, Vienna University of Economics and Business, Welthandelsplatz 1, Wien, 1020, Austria
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Jörg Hoewner
- K12 Agentur für Kommunikation und Innovation GmbH, Schirmerstr. 76, 40211, Düsseldorf, Germany
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Luneburg, Universitätsallee 1, 21335, Lüneburg, Germany
| | - Christian Schwens
- Chair for Entrepreneurship and Management, Faculty of Management, Economics and Social Sciences, University of Cologne, Albertus‑Magnus‑Platz, 50923, Köln, Germany
| | - Stefan Süß
- Chair of Business Administration, in particular Work, Human Resource Management and Organization Studies, Faculty of Business Administration and Economics, Heinrich-Heine-University Dusseldorf, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | - Ines C Wulf
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
- German Social Accident Insurance Institution for the Administrative Sector, Markgrafenstraße 18, 10969, Berlin, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| |
Collapse
|
2
|
Kersten L, Alfano J, Erlanger TE, Helfenstein F, Lanz L, Weiss S, Chilla C, von Planta B, Kapoor M, Borel N, Rocco T, Papageorgiou A, De Brito CF, Bajrami A, Savary V, Mayor M, Hurschler J, Traut A, Brunner D, Vriends N, Stadler C. START NOW WebApp-promoting emotion regulation and resilience in residential youth care and correctional institutions: study protocol for a cluster randomized controlled trial. Trials 2024; 25:341. [PMID: 38778383 PMCID: PMC11112814 DOI: 10.1186/s13063-024-08180-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Adolescents and young adults in residential care and correctional institutions face various challenges, leading to negative life outcomes. Implementation barriers within these institutions, such as limited financial and spatial resources, pose significant hurdles to providing necessary support. Web-based approaches address these challenges by offering cost-effective, accessible solutions. This study aims to assess the efficacy of a newly developed web-based version of the existing evidence-based START NOW skills training in fostering emotion regulation and resilience among institutionalized adolescents and young adults. We present the study protocol (Version 5, August 2023) of the trial titled "Implementation of an e-version of the skills training START NOW for promoting emotion regulation and resilience in residential youth care and correctional institutions". METHODS The study is a monocentric, prospective, confirmatory randomized controlled trial with 150 institutionalized adolescents and young adults with a need to improve resilience (predefined cut-offs). Participating institutions will be randomized to one of three conditions: (i) 9-week web-based group training guided by a facilitator, (ii) 9-week web-based self-help training, (iii) and treatment as usual. The primary endpoint is the change in psychological flexibility, assessed by the Avoidance and Fusion Questionnaire for Youth score, from baseline to follow-up 12 weeks post skills training. Secondary objectives encompass assessing pre-post changes in psychological flexibility and other psychological health-related outcome measures in participating adolescents, young adults, and caretakers from baseline, to post training, and to 12- and 24-week follow-ups. DISCUSSION This study evaluates the efficacy of START NOW as web-based training for institutionalized adolescents and young adults, providing valuable insights into web-based interventions and aiming to optimize support levels. TRIAL REGISTRATION {2A AND 2B}: ClinicalTrials.gov NCT05313581. Registered on 6 April 2022.
Collapse
Affiliation(s)
- Linda Kersten
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Janine Alfano
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Tobias E Erlanger
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Fabrice Helfenstein
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Lelia Lanz
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Stefan Weiss
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Chiara Chilla
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Beryll von Planta
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Madlaina Kapoor
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Nathalie Borel
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Tabea Rocco
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Andreas Papageorgiou
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Catarina Fernandes De Brito
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Arzie Bajrami
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Valentine Savary
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Melanie Mayor
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Jana Hurschler
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Alex Traut
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Donja Brunner
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland.
| | - Noortje Vriends
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Christina Stadler
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| |
Collapse
|
3
|
Cunningham AC, Prentice C, Peven K, Wickham A, Bamford R, Radovic T, Klepchukova A, Fomina M, Cunningham K, Hill S, Hantsoo L, Payne J, Zhaunova L, Ponzo S. Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e54124. [PMID: 38696773 PMCID: PMC11099814 DOI: 10.2196/54124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Reproductive health literacy and menstrual health awareness play a crucial role in ensuring the health and well-being of women and people who menstruate. Further, awareness of one's own menstrual cycle patterns and associated symptoms can help individuals identify and manage conditions of the menstrual cycle such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Digital health products, and specifically menstrual health apps, have the potential to effect positive change due to their scalability and ease of access. OBJECTIVE The primary aim of this study was to measure the efficacy of a menstrual and reproductive health app, Flo, in improving health literacy and health and well-being outcomes in menstruating individuals with and without PMS and PMDD. Further, we explored the possibility that the use of the Flo app could positively influence feelings around reproductive health management and communication about health, menstrual cycle stigma, unplanned pregnancies, quality of life, work productivity, absenteeism, and body image. METHODS We conducted 2 pilot, 3-month, unblinded, 2-armed, remote randomized controlled trials on the effects of using the Flo app in a sample of US-based (1) individuals who track their cycles (n=321) or (2) individuals who track their cycles and are affected by PMS or PMDD (n=117). RESULTS The findings revealed significant improvements at the end of the study period compared to baseline for our primary outcomes of health literacy (cycle tracking: D̄=1.11; t311=5.73, P<.001; PMS or PMDD: D̄=1.20; t115=3.76, P<.001) and menstrual health awareness (D̄=3.97; t311=7.71, P<.001), health and well-being (D̄=3.44; t311=5.94, P<.001), and PMS or PMDD symptoms burden (D̄=-7.08; t115=-5.44, P<.001). Improvements were also observed for our secondary outcomes of feelings of control and management over health (D̄=1.01; t311=5.08, P<.001), communication about health (D̄=0.93; t311=2.41, P=.002), menstrual cycle stigma (D̄=-0.61; t311=-2.73, P=.007), and fear of unplanned pregnancies (D̄=-0.22; t311=-2.11, P=.04) for those who track their cycles, as well as absenteeism from work and education due to PMS or PMDD (D̄=-1.67; t144=-2.49, P=.01). CONCLUSIONS These pilot randomized controlled trials demonstrate that the use of the Flo app improves menstrual health literacy and awareness, general health and well-being, and PMS or PMDD symptom burden. Considering the widespread use and affordability of the Flo app, these findings show promise for filling important gaps in current health care provisioning such as improving menstrual knowledge and health. TRIAL REGISTRATION OSF Registries osf.io/pcgw7; https://osf.io/pcgw7 ; OSF Registries osf.io/ry8vq; https://osf.io/ry8vq.
Collapse
Affiliation(s)
| | | | - Kimberly Peven
- Flo Health UK Limited, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Tara Radovic
- Flo Health UK Limited, London, United Kingdom
- Department of Psychology and Ergonomics, Technische Universitaet Berlin, Berlin, Germany
| | | | - Maria Fomina
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Katja Cunningham
- Department of Psychology, Texas Christian University, Fort Worth, TX, United States
| | - Sarah Hill
- Department of Psychology, Texas Christian University, Fort Worth, TX, United States
| | - Liisa Hantsoo
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Jennifer Payne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
| | | | - Sonia Ponzo
- Flo Health UK Limited, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
| |
Collapse
|
4
|
Lam LT, Lam MKP. A Web-Based and Mobile Intervention Program Using a Spaced Education Approach for Workplace Mental Health Literacy: Cluster Randomized Controlled Trial. JMIR Ment Health 2024; 11:e51791. [PMID: 38654570 PMCID: PMC11063580 DOI: 10.2196/51791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/23/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024] Open
Abstract
Background Workplace mental health is an important global health concern. objectives This unblinded, phase-III, wait-listed cluster randomized controlled trial aimed to examine the effectiveness of a mobile health (mHealth) psychoeducation program using a spaced education approach on mental health literacy (MHL) in the workplace. The main interest of this paper was the immediate and 3-month medium-term effect of the program on the MHL of workers. The purposely built mHealth platform was also evaluated as a health-related app. Methods The mHealth platform was designed using the principle of spaced education as a psychoeducation intervention program, with various modules of web-based and mobile materials presented to the participant in a progressive manner. Short quizzes at the end of each module ensured adequate learning, and successful completion qualified the learner to progress to the next level. The trial recruited 456 employees of specific industries with high levels of work-related stress. Participants who were nested in different offices or units were allocated into the intervention and wait-listed control groups using a block randomization process, with the office or unit as the cluster. A separate sample of 70 individual raters were used for the evaluation of the mHealth platform. The Australian National MHL and Stigma Survey and the Mobile Apps Rating Scale were completed through a web-based self-reported survey to assess MHL and evaluate the app. The trial and follow-up data were analyzed by a generalized linear latent and mixed model with adjustments for the clustering effect of work sites and repeated measures. Results Of the 456 participants in the trial, 236 (51.8%) responded to the follow-up survey. Most MHL outcomes obtained significant results immediately after the intervention and across time. After adjusting for the clustering effect, the postintervention weighted mean scores were significantly higher in the intervention group than the control group for correct recognition of a mental health problem, help seeking, and stigmatization by 0.2 (SE 0.1; P=.003), 0.9 (SE 0.2; P<.001), and 1.8 (SE 0.4; P<.001), respectively. After adjusting for the clustering effect, significant differences across time were found in help-seeking intention (P=.01), stigmatization (P<.001), and social distancing (P<.001). The evaluation of the mHealth program resulted in average scores of the 4 major domains ranging from 3.8 to 4.2, with engagement having the lowest score. Conclusions The mHealth psychoeducation intervention program using this platform had immediate and 3-month medium-term effects of retaining and improving MHL. The platform was evaluated to have satisfactory performance in terms of functionality, aesthetics, information content, and utility in enhancing MHL. It is anticipated that ongoing development in digital health will provide great benefits in improving the mental health of the global population.
Collapse
Affiliation(s)
- Lawrence T Lam
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mary K P Lam
- STEM College, RMIT University, Melbourne, Australia
| |
Collapse
|
5
|
Woodard KT, Bailey AM, Esagoff AI, Fragala MS, Hayward JI, Hunter JL, Hsu YJ, Kim PM, Peters ME, Carr SM. A population health approach to workplace mental health: rationale, implementation and engagement. Front Public Health 2024; 12:1336898. [PMID: 38699412 PMCID: PMC11064789 DOI: 10.3389/fpubh.2024.1336898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/13/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives To describe a population health-based program to support employee and dependent mental health and learn from engagement trends. Methods Retrospective analysis of a program utilizing an assessment of mental health risk. For scoring "at risk," a Care Concierge is offered to connect users with resources. Results Participation was offered to 56,442 employees and dependents. Eight thousand seven hundred thirty-one completed the assessment (15%). Of those, 4,644 (53%) scored moderate or higher. A total of 418 (9%) engaged the Care Concierge. Factors that negatively influenced the decision to engage care included bodily pain, financial concerns. Positive influences were younger age, high stress, anxiety, PTSD and low social support. Conclusion Proactive assessment plus access to a Care Concierge facilitates mental healthcare utilization. Several factors influence likelihood to engage in care. A better understanding of these factors may allow for more targeted outreach and improved engagement.
Collapse
Affiliation(s)
- Kaylee T. Woodard
- Louisiana State University Health Sciences Center—New Orleans, New Orleans, LA, United States
| | - Allison M. Bailey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Aaron I. Esagoff
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | | | | | - Yea-Jen Hsu
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Paul M. Kim
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Matthew E. Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Susan M. Carr
- Johns Hopkins Healthcare, Baltimore, MD, United States
| |
Collapse
|
6
|
Kassie AM, Eakin E, Abate BB, Endalamaw A, Zewdie A, Wolka E, Assefa Y. The use of positive deviance approach to improve health service delivery and quality of care: a scoping review. BMC Health Serv Res 2024; 24:438. [PMID: 38589897 PMCID: PMC11003118 DOI: 10.1186/s12913-024-10850-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/11/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Quality has been a persistent challenge in the healthcare system, particularly in resource-limited settings. As a result, the utilization of innovative approaches is required to help countries in their efforts to enhance the quality of healthcare. The positive deviance (PD) approach is an innovative approach that can be utilized to improve healthcare quality. The approach assumes that solutions to problems are already available within the community and identifying and sharing those solutions can help others to resolve existing issues. Therefore, this scoping review aimed to synthesize the evidence regarding the use of the PD approach in healthcare system service delivery and quality improvement programs. METHODS Articles were retrieved from six international databases. The last date for article search was June 02, 2023, and no date restriction was applied. All articles were assessed for inclusion through a title and/or abstract read. Then, articles that passed the title and abstract review were screened by reading their full texts. In case of duplication, only the full-text published articles were retained. A descriptive mapping and evidence synthesis was done to present data with the guide of the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist and the results are presented in text, table, and figure formats. RESULTS A total of 125 articles were included in this scoping review. More than half, 66 (52.8%), of the articles were from the United States, 11(8.8%) from multinational studies, 10 (8%) from Canada, 8 (6.4%) from the United Kingdom and the remaining, 30 (24%) are from other nations around the world. The scoping review indicates that several types of study designs can be applied in utilizing the PD approach for healthcare service and quality improvement programs. However, although validated performance measures are utilized to identify positive deviants (PDs) in many of the articles, some of the selection criteria utilized by authors lack clarity and are subject to potential bias. In addition, several limitations have been mentioned in the articles including issues in operationalizing PD, focus on leaders and senior managers and limited staff involvement, bias, lack of comparison, limited setting, and issues in generalizability/transferability of results from prospects perspective. Nevertheless, the limitations identified are potentially manageable and can be contextually resolved depending on the nature of the study. Furthermore, PD has been successfully employed in healthcare service and quality improvement programs including in increasing surgical care quality, hand hygiene practice, and reducing healthcare-associated infections. CONCLUSION The scoping review findings have indicated that healthcare systems have been able to enhance quality, reduce errors, and improve patient outcomes by identifying lessons from those who exhibit exceptional practices and implementing successful strategies in their practice. All the outcomes of PD-based research, however, are dependent on the first step of identifying true PDs. Hence, it is critical that PDs are identified using objective and validated measures of performance as failure to identify true PDs can subsequently lead to failure in identifying best practices for learning and dissemination to other contextually similar settings.
Collapse
Affiliation(s)
- Ayelign Mengesha Kassie
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia.
| | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Biruk Beletew Abate
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Aklilu Endalamaw
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care, Ethiopia, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care, Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
7
|
Sasaki N, Shimazu T, Takeno H, Ogawa S, Sawada U, Tsutsumi A, Imamura K. Implementation of an internet-based stress management program in micro- and small-sized enterprises: a study protocol for a pre-post feasibility study of the effectiveness-implementation hybrid type 2 trial. Pilot Feasibility Stud 2024; 10:56. [PMID: 38581058 PMCID: PMC10996202 DOI: 10.1186/s40814-024-01481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/12/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Although internet-based stress management programs are proven effective in improving mental health among workers, micro- and small-sized enterprises (MSEs), lacking in occupational healthcare services, face challenges implementing them. To address this gap, this study will develop the program with stakeholders at MSEs to aim for real-world implementation. OBJECTIVES This paper describes a study protocol for a pre-post feasibility study of an effectiveness-implementation hybrid type 2 trial of text-based internet-based programs ("WellBe-LINE") in MSEs with less than 50 employees. This feasibility study primarily aims to evaluate trial methods for future effectiveness-implementation hybrid type 2 trials. METHODS For this study protocol, an internet- and text-based self-care intervention program using the LINE app (a popular message tool in Japan) will be prepared according to evidence-based psychoeducational topics. Based on our online survey findings, personalized algorithms will be implemented according to employees' gender, age, and psychological distress levels. A personalized program using a popular pre-existing text app is expected to reduce employees' burdens and be attractive to them, resulting in successful implementation outcomes and mental health benefits. A pre-post design feasibility study will be conducted on ten companies to evaluate trial methods (e.g., recruitment and procedures). The primary outcome will involve individual-level penetration, defined as the proportion of the number of employees who register for the program divided by the total number of invited employees at the company. The progression criterion to go next trial specifies that more than 50% of the recruited companies obtain 60% individual penetration, which is set based on the findings of the prior survey of employees at MSEs and of interviews of stakeholders involved in this study, and will be measured by LINE system. Finally, acceptability, appropriateness, and feasibility will be measured using internet-based questionnaires and interviews. DISCUSSION This pre-post feasibility study for future effectiveness-implementation hybrid type 2 trials will provide in-depth knowledge about the successful implementation of text-based, semi-personalized, self-care mental health interventions in real-world settings using both quantitative and qualitative data. CONCLUSIONS This feasibility study will help validate the effectiveness of text-based interventions using a widely used social networking service (SNS) tool for employees in MSEs. TRIAL REGISTRATION UMIN clinical trial registration, UMIN000046960. Registered on February 21, 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053570.
Collapse
Affiliation(s)
- Natsu Sasaki
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Hajime Takeno
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sayaka Ogawa
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Utako Sawada
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akizumi Tsutsumi
- Department of Public Health, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kotaro Imamura
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| |
Collapse
|
8
|
Raggi A, Bernard RM, Toppo C, Sabariego C, Salvador Carulla L, Lukersmith S, Hakkaart-van Roijen L, Merecz-Kot D, Olaya B, Antunes Lima R, Gutiérrez-Marín D, Vorstenbosch E, Curatoli C, Cacciatore M. The EMPOWER Occupational e-Mental Health Intervention Implementation Checklist to Foster e-Mental Health Interventions in the Workplace: Development Study. J Med Internet Res 2024; 26:e48504. [PMID: 38488846 PMCID: PMC10980995 DOI: 10.2196/48504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/29/2023] [Accepted: 12/21/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Occupational e-mental health (OeMH) interventions significantly reduce the burden of mental health conditions. The successful implementation of OeMH interventions is influenced by many implementation strategies, barriers, and facilitators across contexts, which, however, are not systematically tracked. One of the reasons is that international consensus on documenting and reporting the implementation of OeMH interventions is lacking. There is a need for practical guidance on the key factors influencing the implementation of interventions that organizations should consider. Stakeholder consultations secure a valuable source of information about these key strategies, barriers, and facilitators that are relevant to successful implementation of OeMH interventions. OBJECTIVE The objective of this study was to develop a brief checklist to guide the implementation of OeMH interventions. METHODS Based on the results of a recently published systematic review, we drafted a comprehensive checklist with a wide set of strategies, barriers, and facilitators that were identified as relevant for the implementation of OeMH interventions. We then used a 2-stage stakeholder consultation process to refine the draft checklist to a brief and practical checklist comprising key implementation factors. In the first stage, stakeholders evaluated the relevance and feasibility of items on the draft checklist using a web-based survey. The list of items comprised 12 facilitators presented as statements addressing "elements that positively affect implementation" and 17 barriers presented as statements addressing "concerns toward implementation." If a strategy was deemed relevant, respondents were asked to rate it using a 4-point Likert scale ranging from "very difficult to implement" to "very easy to implement." In the second stage, stakeholders were interviewed to elaborate on the most relevant barriers and facilitators shortlisted from the first stage. The interview mostly focused on the relevance and priority of strategies and factors affecting OeMH intervention implementation. In the interview, the stakeholders' responses to the open survey's questions were further explored. The final checklist included strategies ranked as relevant and feasible and the most relevant facilitators and barriers, which were endorsed during either the survey or the interviews. RESULTS In total, 26 stakeholders completed the web-based survey (response rate=24.8%) and 4 stakeholders participated in individual interviews. The OeMH intervention implementation checklist comprised 28 items, including 9 (32.1%) strategies, 8 (28.6%) barriers, and 11 (39.3%) facilitators. There was widespread agreement between findings from the survey and interviews, the most outstanding exception being the idea of proposing OeMH interventions as benefits for employees. CONCLUSIONS Through our 2-stage stakeholder consultation, we developed a brief checklist that provides organizations with a guide for the implementation of OeMH interventions. Future research should empirically validate the effectiveness and usefulness of the checklist.
Collapse
Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Claudia Toppo
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Carla Sabariego
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems, University of Lucerne, Lucerne, Switzerland
| | - Luis Salvador Carulla
- Health Research Institute, University of Canberra, Canberra, Australia
- Healthcare Information Systems (CTS553), University of Cadiz, Cadiz, Spain
| | - Sue Lukersmith
- Health Research Institute, University of Canberra, Canberra, Australia
| | | | | | - Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Rodrigo Antunes Lima
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Desirée Gutiérrez-Marín
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Ellen Vorstenbosch
- Swiss Paraplegic Research, Nottwil, Switzerland
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Chiara Curatoli
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Martina Cacciatore
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| |
Collapse
|
9
|
Mopkins D, Lee M, Malecha A. Personal, Social, and Workplace Environmental Factors Related to Psychological Well-Being of Staff in University Settings. Workplace Health Saf 2024; 72:108-118. [PMID: 38229557 DOI: 10.1177/21650799231214249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Understanding the psychological well-being (PWB) of university staff and factors that influence it is critical for developing intervention programs that promote PWB and enhance productivity and worker engagement. PURPOSE This study aimed to assess the level of PWB in university staff and identify personal, social, and workplace environmental factors related to their PWB. METHODS A cross-sectional, correlational study design was used. A convenience sample of university staff was recruited from two universities in Texas. Participants completed an online questionnaire, which included Ryff's PWB scale to measure PWB, along with questions related to personal, social, and workplace factors. Hierarchical multiple regression was used to analyze the influence of these factors on the PWB of university staff. RESULTS The PWB of university staff (n = 202) was significantly influenced by personal factors (i.e., race and perceived mental health status), social factors (i.e., social support of friends), and workplace environmental factors (i.e., physical demands). CONCLUSION/APPLICATION TO PRACTICE To effectively promote PWB among university staff, occupational health nurses should proactively track and monitor their PWB. Policies and interventions should consider the various personal, social, and workplace environment factors identified in this study, such as mental health, social support resources, and physical demands.
Collapse
Affiliation(s)
| | - Mikyoung Lee
- Texas Woman's University College of Nursing, Dallas
| | - Ann Malecha
- Texas Woman's University College of Nursing, Houston
| |
Collapse
|
10
|
Krisher L, Boeldt DL, Sigmon CAN, Rimel SE, Newman LS. Pragmatic Approach to the Assessment and Use of Digital Mental Health Interventions for Health Workers. Am J Public Health 2024; 114:171-179. [PMID: 38354345 PMCID: PMC10916727 DOI: 10.2105/ajph.2023.307505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 02/16/2024]
Abstract
Symptoms of poor mental health among working people, especially health workers, are on the rise in the United States, contributing to a burgeoning market of thousands of mental health technology products, few of which have undergone rigorous evaluation. Most research on these products focuses on deploying digital mental health interventions as ancillary support in clinical practice and community settings. Little is known of the effectiveness of these tools when employers offer them. We describe the landscape of digital mental health interventions, providing an overview of mental health conditions that are addressed with technology-based solutions in the workplace and the products and services available. We argue for employers to apply a methodical approach to evaluating and selecting technologies for their organizations, and we review relevant frameworks for evaluation. Considering the rapidly evolving landscape of digital mental health interventions, we offer evidence-informed recommendations to organizations and decision-makers seeking to support workplace mental health and well-being, and we advocate the development of products that help organizations assess how they can mitigate workplace conditions that may contribute to poorer mental health. (Am J Public Health. 2024;114(S2):S171-S179. https://doi.org/10.2105/AJPH.2023.307505).
Collapse
Affiliation(s)
- Lyndsay Krisher
- Lyndsay Krisher is with the Center for Health, Work & Environment and the Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Debra L. Boeldt, Chloe A. Nicksic Sigmon, and Sarah E. Rimel are with the National Mental Health Innovation Center, University of Colorado Anschutz Medical Campus. Lee S. Newman is with the Center for Health, Work & Environment and the Department of Environmental & Occupational Health, Colorado School of Public Health, Aurora
| | - Debra L Boeldt
- Lyndsay Krisher is with the Center for Health, Work & Environment and the Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Debra L. Boeldt, Chloe A. Nicksic Sigmon, and Sarah E. Rimel are with the National Mental Health Innovation Center, University of Colorado Anschutz Medical Campus. Lee S. Newman is with the Center for Health, Work & Environment and the Department of Environmental & Occupational Health, Colorado School of Public Health, Aurora
| | - Chloe A Nicksic Sigmon
- Lyndsay Krisher is with the Center for Health, Work & Environment and the Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Debra L. Boeldt, Chloe A. Nicksic Sigmon, and Sarah E. Rimel are with the National Mental Health Innovation Center, University of Colorado Anschutz Medical Campus. Lee S. Newman is with the Center for Health, Work & Environment and the Department of Environmental & Occupational Health, Colorado School of Public Health, Aurora
| | - Sarah E Rimel
- Lyndsay Krisher is with the Center for Health, Work & Environment and the Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Debra L. Boeldt, Chloe A. Nicksic Sigmon, and Sarah E. Rimel are with the National Mental Health Innovation Center, University of Colorado Anschutz Medical Campus. Lee S. Newman is with the Center for Health, Work & Environment and the Department of Environmental & Occupational Health, Colorado School of Public Health, Aurora
| | - Lee S Newman
- Lyndsay Krisher is with the Center for Health, Work & Environment and the Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Debra L. Boeldt, Chloe A. Nicksic Sigmon, and Sarah E. Rimel are with the National Mental Health Innovation Center, University of Colorado Anschutz Medical Campus. Lee S. Newman is with the Center for Health, Work & Environment and the Department of Environmental & Occupational Health, Colorado School of Public Health, Aurora
| |
Collapse
|
11
|
Fannin A, Hooley C, Reeves CJ, Marçal K, Treglown R, Woerner R. Occupational burnout and public stigma associated with employee mental well-being: A multi-industry, cross-sectional study during COVID-19. Work 2024; 77:49-59. [PMID: 37483050 DOI: 10.3233/wor-220507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND While mental illness (e.g., depression, anxiety) has been examined frequently in the workplace, the COVID-19 pandemic has only increased the attention towards mental illness. Mental well-being views mental health as a continuum from ill health to thriving. Few studies have examined factors associated with mental well-being in the workplace. Public stigma for mental illness, the general population's negative attitude towards mental illness, and occupational burnout are examined. OBJECTIVE The purpose of this study was to examine the relationship between burnout and public stigma on mental well-being in a sample of employees across industries in the United States. METHODS Employees surveyed from 16 companies from various industries were assessed. Room Here, a non-profit organization whose goal is to improve employee mental fitness, gathered data from these companies located in the western mountain region of the U.S. Data were collected during the pandemic. Across this portfolio of companies, 259 employees were included in the sample. Survey assesses respondents' mental well-being, stigma towards mental illness, and occupational burnout. Ordinary least squares (OLS) regression was used in this cross-sectional study on secondary data. RESULTS Results suggested occupational burnout was associated with a decrease in mental well-being, while public stigma was associated with an improvement in mental well-being. CONCLUSION This study sought to examine the relationship between mental well-being, burnout, and public stigma. Employee burnout and public stigma were related to mental well-being. Implications for burnout and stigma reduction programs are discussed as well as future research.
Collapse
Affiliation(s)
- Austin Fannin
- Industrial/Organizational Psychology, University of Tulsa, Tulsa, OK, USA
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, UT, USA
| | - Cody J Reeves
- Marriott School of Business, Brigham Young University, Provo, UT, USA
| | - Katherine Marçal
- School of Social Work, Rutgers University, NewBrunswick, NJ, USA
| | | | | |
Collapse
|
12
|
Sarkar S, Menon V, Padhy S, Kathiresan P. Mental health and well-being at the workplace. Indian J Psychiatry 2024; 66:S353-S364. [PMID: 38445278 PMCID: PMC10911318 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_608_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- Siddharth Sarkar
- National Drug Dependence Treatment Centre, New Delhi, India E-mail:
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Susanta Padhy
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Preethy Kathiresan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
13
|
Fonda F, Galazzi A, Chiappinotto S, Justi L, Frydensberg MS, Boesen RL, Macur M, Reig EA, Espaulella ER, Palese A. Healthcare System Digital Transformation across Four European Countries: A Multiple-Case Study. Healthcare (Basel) 2023; 12:16. [PMID: 38200922 PMCID: PMC10778608 DOI: 10.3390/healthcare12010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Digitization has become involved in every aspect of life, including the healthcare sector with its healthcare professionals (HCPs), citizens (patients and their families), and services. This complex process is supported by policies: however, to date, no policy analysis on healthcare digitalization has been conducted in European countries to identify the main goals of digital transformation and its practical implementation. This research aimed to describe and compare the digital health policies across four European countries; namely, their priorities, their implementation in practice, and the digital competencies expected by HCPs. A multiple-case study was performed. Participants were the members of the Digital EducationaL programme invoLVing hEalth profEssionals (DELIVER), a project funded by the European Union under the Erasmus+ programme, involving three countries (Denmark, Italy, and Slovenia) and one autonomous region (Catalonia-Spain). Data were collected using two approaches: (a) a written interview with open-ended questions involving the members of the DELIVER project as key informants; and (b) a policy-document analysis. Interviews were analysed using the textual narrative synthesis and the word cloud policy analysis was conducted according to the Ready, Extract, Analyse and Distil approach. Results showed that all countries had established recent policies at the national level to address the development of digital health and specific governmental bodies were addressing the implementation of the digital transformation with specific ramifications at the regional and local levels. The words "health" and "care" characterized the policy documents of Denmark and Italy (309 and 56 times, 114 and 24 times, respectively), while "development" and "digital" (497 and 478 times, respectively) were common in the Slovenia document. The most used words in the Catalonia policy document were "data" and "system" (570 and 523 times, respectively). The HCP competencies expected are not clearly delineated among countries, and there is no formal plan for their development at the undergraduate, postgraduate, and continuing educational levels. Mutual understanding and exchange of good practices between countries may facilitate the digitalization processes; moreover, concrete actions in the context of HCP migration across Europe for employment purposes, as well as in the context of citizens' migration for healthcare-seeking purposes are needed to consider the differences emerged across the countries.
Collapse
Affiliation(s)
- Federico Fonda
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (F.F.); (A.P.)
| | - Alessandro Galazzi
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (F.F.); (A.P.)
| | - Stefania Chiappinotto
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (F.F.); (A.P.)
| | - Linda Justi
- Health Innovation Centre of Southern Denmark, Forskerparken 10, 5230 Odense, Denmark; (L.J.); (M.S.F.); (R.L.B.)
| | | | - Randi Lehmann Boesen
- Health Innovation Centre of Southern Denmark, Forskerparken 10, 5230 Odense, Denmark; (L.J.); (M.S.F.); (R.L.B.)
| | - Mirna Macur
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, 4270 Jesenice, Slovenia;
| | - Erik Andrés Reig
- TIC Salut Social, Carrer de Roc Boronat 81, 08005 Barcelona, Catalonia, Spain; (E.A.R.); (E.R.E.)
| | | | - Alvisa Palese
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (F.F.); (A.P.)
| |
Collapse
|
14
|
Faria M, Zin STP, Chestnov R, Novak AM, Lev-Ari S, Snyder M. Mental Health for All: The Case for Investing in Digital Mental Health to Improve Global Outcomes, Access, and Innovation in Low-Resource Settings. J Clin Med 2023; 12:6735. [PMID: 37959201 PMCID: PMC10649112 DOI: 10.3390/jcm12216735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Mental health disorders are an increasing global public health concern that contribute to morbidity, mortality, disability, and healthcare costs across the world. Biomedical and psychological research has come a long way in identifying the importance of mental health and its impact on behavioral risk factors, physiological health, and overall quality of life. Despite this, access to psychological and psychiatric services remains widely unavailable and is a challenge for many healthcare systems, particularly those in developing countries. This review article highlights the strengths and opportunities brought forward by digital mental health in narrowing this divide. Further, it points to the economic and societal benefits of effectively managing mental illness, making a case for investing resources into mental healthcare as a larger priority for large non-governmental organizations and individual nations across the globe.
Collapse
Affiliation(s)
- Manuel Faria
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA;
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
- Health and Development, United Nations Development Programme, 1219 Geneva, Switzerland; (S.T.P.Z.); (R.C.)
| | - Stella Tan Pei Zin
- Health and Development, United Nations Development Programme, 1219 Geneva, Switzerland; (S.T.P.Z.); (R.C.)
| | - Roman Chestnov
- Health and Development, United Nations Development Programme, 1219 Geneva, Switzerland; (S.T.P.Z.); (R.C.)
| | - Anne Marie Novak
- Department of Health Promotion, Tel Aviv University School of Medicine, Tel Aviv 6997801, Israel;
| | - Shahar Lev-Ari
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA;
- Department of Health Promotion, Tel Aviv University School of Medicine, Tel Aviv 6997801, Israel;
| | - Michael Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA;
| |
Collapse
|
15
|
Dierich A, Schmidt K, Lison A, Schulze C, Schmeil M, Löffler C, Altiner A. [Analysis of Sickness-Related Days of Absence among Soldiers of the German Armed Forces from 2008 to 2018 Part 1: Retrospective Analysis with Comparison to the Statutory Health Insurance System]. DAS GESUNDHEITSWESEN 2023; 85:878-886. [PMID: 36848946 DOI: 10.1055/a-1987-5847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Sickness-related absences are of particular importance both in the German armed forces and in the civilian sector. THE AIM OF THIS STUDY was to analyze the incidence of sick leave among soldiers in comparison to the working population covered by the statutory health insurance (SHI) system. METHOD According to the systematics of the SHI, the key figures on incapacity to work in the period 2008-2018 are calculated in an age- and gender-standardized manner. Likewise, a list of the TOP 20 ICD-10 diagnoses in relation to incapacity to work was determined, and their average annual rates of change were calculated for trend analysis. RESULTS The annual rate of sick leave among soldiers was between 1.5 and 2.3%, which was lower than that of the SHI (3.1 to 5.0%). The duration of illness (sick days per case) among soldiers was between 9.0-15.6 days per year, compared with 10.9-14.4 days in the SHI system. The sickness frequency (cases per 100 persons) was lower among soldiers (48.2-75.0 cases) than in the SHI (96.8-131.0 cases). Most days of absence among soldiers were due to "respiratory infections (J06)" with 13.2%, "stress reactions (F43)" with 8.7%, "other infectious gastroenteritis and colitis (A09)" with 6.5%, "back pain (M54)" with 4.4% and "depressive episode (F32)" with 4.0% of all days of absence and were comparable to the values in SHI. "Depressive episode (F32)", "injuries (T14)", sreactions (F43)", "respiratory infections (J06)" and "pregnancy complaints (O26)" showed the highest rates of increase of+6.1% to+3.6% of days off work. CONCLUSION For the first time, it was possible to compare the sickness rate of soldiers with that of the general population in Germany, which may also provide indications for further measures for primary, secondary and tertiary prevention. The lower sickness rate among soldiers compared with the general population is mainly due to a lower incidence of illness, with a similar duration and pattern of illness, but with an overall upward trend. The ICD-10 diagnoses "Depressive episode (F32)," "injuries (T14)," "stress reactions (F43)," "acute upper respiratory tract infections (J06)" and "pregnancy complaints (O26)," which are increasing at an above-average rate in relation to the number of days absent, require further analysis. This approach seems promising, for example, to generate hypotheses and ideas for further improvement of health care.
Collapse
Affiliation(s)
- Andreas Dierich
- Leiter, Sanitätsunterstützungszentrum Neubrandenburg, Trollenhagen, Germany
| | - Kristin Schmidt
- Qualitätsmanagement, Sanitätsunterstützungszentrum Neubrandenburg, Neubrandenburg, Germany
| | - Andreas Lison
- Leiter, Zentrum für Sportmedizin der Bundeswehr, Warendorf, Germany
| | - Christoph Schulze
- Orthopädie, Zentrum für Sportmedizin der Bundeswehr, Warendorf, Germany
| | - Melanie Schmeil
- Epidemiologie, Institut für Präventivmedizin der Bundeswehr, Andernach, Germany
| | - Christin Löffler
- Institut für Allgemeinmedizin, Universitätsmedizin Rostock, Rostock, Germany
| | - Attila Altiner
- Institut für Allgemeinmedizin, Universitätsmedizin Rostock, Rostock, Germany
| |
Collapse
|
16
|
Dohi Y, Imamura K, Sasaki N, Komase Y, Sakuraya A, Nakamura Y, Maejima M, Aoyama M, Kawakami N, Miyamoto Y. Effects of an Internet Delivered Behavioral Activation Program on Improving Work Engagement Among Japanese Workers: A Pretest and Posttest Study. J Occup Environ Med 2023; 65:e654-e659. [PMID: 37505082 DOI: 10.1097/jom.0000000000002933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
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.
Collapse
Affiliation(s)
- Yuri Dohi
- From the Department of Psychiatric Nursing, Graduate school of Medicine, University of Tokyo, Tokyo, Japan (Y.D., Y.M.); Department of Mental health, Graduate school of Medicine, University of Tokyo, Tokyo, Japan (K.I., N.S., A.S., N.K.); and Fujitsu Japan Limited, Tokyo, Japan (Y.K., Y.N., M.M., M.A.)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Echeverría G, Samith B, von Schultzendorf A, Pinto V, Martínez X, Sara D, Calzada M, Pacheco J, Plaza G, Scott F, Romero J, Mateo C, Julio MV, Utreras-Mendoza Y, Binder MV, Gutiérrez F, Riquelme ME, Cuevas M, Willatt R, Sánchez O, Keilendt A, Butrón P, Jarufe A, Huete I, Tobar J, Martin S, Alfaro V, Olivos M, Pedrals N, Bitran M, Ávalos I, Ruini C, Ryff C, Pérez D, Berkowitz L, Rigotti A. Mediterranean diet and psychological well-being intervention to reverse metabolic syndrome in Chile (CHILEMED trial). Contemp Clin Trials Commun 2023; 35:101167. [PMID: 37538196 PMCID: PMC10393605 DOI: 10.1016/j.conctc.2023.101167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/06/2023] [Accepted: 06/18/2023] [Indexed: 08/05/2023] Open
Abstract
Psychosocial status and lifestyle are key risk factors of non-communicable diseases (NCDs), which, in turn, are main drivers of healthcare costs and morbimortality worldwide, including Chile. Mediterranean diet (MedDiet) is one of the healthiest dietary patterns under study. However, its impact on high-risk conditions, such as metabolic syndrome (MetS), and NCDs outside the Mediterranean Basin remains mostly unexplored. Even though Central Chile has an environment, food production, and culinary traditions comparable to those present in Mediterranean countries, few studies -some with significant methodological limitations- have evaluated the effect of MedDiet on health and/or disease in Chilean subjects. Importantly, a Mediterranean lifestyle is a modus vivendi that integrates physical health with mental and social well-being. Psychological well-being (PWB) is associated with healthy behaviors, positive health outcomes, and longevity, thereby emerging as a novel healthcare goal. We report here an ongoing randomized controlled clinical trial in Chilean patients with MetS seeking to test whether (1) a PWB theory-based intervention facilitates induction to and increases long-term adherence to a locally adapted MedDiet, and (2) a MedDiet intervention -implemented alone or combined with well-being promotion- is more effective at reversing MetS compared to individuals following a low-fat diet without psychological support. The CHILEan MEDiterranean (CHILEMED) diet intervention study is a 1-year trial including patients with MetS living in Chile. Participants will be assigned randomly by a computer-generated random number sequence to one of the three intervention arms: a) low-fat diet as control group, b) MedDiet alone, and c) MedDiet plus well-being support. Patients will be followed-up by individual and/or group online nutritional sessions or phone cal as well as 6- and 12-month in-person re-assessment of medical history, medication use, food intake, PWB, anthropometrics/physical exam, and blood collection for laboratory analysis. The primary outcome of the trial will be the effect of the MedDiet -with or without PWB intervention- on overall reversal of MetS compared to low-fat diet alone. Based on a statistical superiority trial, expected impact, and patient loss, the estimated study sample is 339 subjects (113 individuals per arm in 3 equal-sized groups). Currently, we have enrolled 179 patients, predominantly women, evenly distributed by age (group means ranging from 45.7 to 48,9 years-old), 3/4 are obese with almost all of them showing abdominal obesity, 70% are hypertensive, whereas <10% exhibit diabetes. If findings turn out as expected (e.g., MedDiet -with or without PWB intervention- is better than the low-fat diet for reversion of MetS at 1-year follow-up), CHILEMED will provide further beneficial evidence of the MedDiet on NCD risk conditions beyond the Mediterranean region.
Collapse
Affiliation(s)
- Guadalupe Echeverría
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Bárbara Samith
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Andrea von Schultzendorf
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Victoria Pinto
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
- Carrera de Nutrición y Dietética, Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Ximena Martínez
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Daniela Sara
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Mariana Calzada
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Josefina Pacheco
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Gianella Plaza
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Francesca Scott
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Javiera Romero
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Camila Mateo
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - María Verónica Julio
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Yildy Utreras-Mendoza
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - María Victoria Binder
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Florencia Gutiérrez
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - María Emilia Riquelme
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Margarita Cuevas
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Rosario Willatt
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Omayra Sánchez
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Aracelli Keilendt
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Patricia Butrón
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Alessandra Jarufe
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Isidora Huete
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Josefina Tobar
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Sofía Martin
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Valentina Alfaro
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Matilde Olivos
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Nuria Pedrals
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Marcela Bitran
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | | | - Chiara Ruini
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - Carol Ryff
- Institute on Aging and Department of Psychology, University of Wisconsin-Madison, Madison, WI, 53706-1611, USA
| | - Druso Pérez
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Loni Berkowitz
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Attilio Rigotti
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| |
Collapse
|
18
|
Snoswell CL, Chelberg G, De Guzman KR, Haydon HH, Thomas EE, Caffery LJ, Smith AC. The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. J Telemed Telecare 2023; 29:669-684. [PMID: 34184580 DOI: 10.1177/1357633x211022907] [Citation(s) in RCA: 127] [Impact Index Per Article: 127.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To promote telehealth implementation and uptake, it is important to assess overall clinical effectiveness to ensure any changes will not adversely affect patient outcomes. The last systematic literature review examining telehealth effectiveness was conducted in 2010. Given the increasing use of telehealth and technological developments in the field, a more contemporary review has been carried out. The aim of this review was to synthesise recent evidence associated with the clinical effectiveness of telehealth services. METHODS A systematic search of 'Pretty Darn Quick'-Evidence portal was carried out in November 2020 for systematic reviews on telehealth, where the primary outcome measure reported was clinical effectiveness. Due to the volume of telehealth articles, only systematic reviews with meta-analyses published between 2010 and 2019 were included in the analysis. RESULTS We found 38 meta-analyses, covering 10 medical disciplines: cardiovascular disease (n = 3), dermatology (n = 1), endocrinology (n = 13), neurology (n = 4), nephrology (n = 2), obstetrics (n = 1), ophthalmology (n = 1), psychiatry and psychology (n = 7), pulmonary (n = 4) and multidisciplinary care (n = 2). The evidence showed that for all disciplines, telehealth across a range of modalities was as effective, if not more, than usual care. DISCUSSION This review demonstrates that telehealth can be equivalent or more clinically effective when compared to usual care. However, the available evidence is very discipline specific, which highlights the need for more clinical effectiveness studies involving telehealth across a wider spectrum of clinical health services. The findings from this review support the view that in the right context, telehealth will not compromise the effectiveness of clinical care when compared with conventional forms of health service delivery.
Collapse
Affiliation(s)
- Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Georgina Chelberg
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Australia
| | - Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Helen H Haydon
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- University of Southern Denmark, Denmark
| |
Collapse
|
19
|
Chokka P, Bender A, Brennan S, Ahmed G, Corbière M, Dozois DJA, Habert J, Harrison J, Katzman MA, McIntyre RS, Liu YS, Nieuwenhuijsen K, Dewa CS. Practical pathway for the management of depression in the workplace: a Canadian perspective. Front Psychiatry 2023; 14:1207653. [PMID: 37732077 PMCID: PMC10508062 DOI: 10.3389/fpsyt.2023.1207653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023] Open
Abstract
Major depressive disorder (MDD) and other mental health issues pose a substantial burden on the workforce. Approximately half a million Canadians will not be at work in any week because of a mental health disorder, and more than twice that number will work at a reduced level of productivity (presenteeism). Although it is important to determine whether work plays a role in a mental health condition, at initial presentation, patients should be diagnosed and treated per appropriate clinical guidelines. However, it is also important for patient care to determine the various causes or triggers including work-related factors. Clearly identifying the stressors associated with the mental health disorder can help clinicians to assess functional limitations, develop an appropriate care plan, and interact more effectively with worker's compensation and disability programs, as well as employers. There is currently no widely accepted tool to definitively identify MDD as work-related, but the presence of certain patient and work characteristics may help. This paper seeks to review the evidence specific to depression in the workplace, and provide practical tips to help clinicians to identify and treat work-related MDD, as well as navigate disability issues.
Collapse
Affiliation(s)
- Pratap Chokka
- Department of Psychiatry, University of Alberta, Grey Nuns Hospital, Edmonton, AB, Canada
| | - Ash Bender
- Work, Stress and Health Program, The Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Stefan Brennan
- Department of Psychiatry, University of Saskatchewan, Royal University Hospital, Saskatoon, SK, Canada
| | - Ghalib Ahmed
- Department of Family Medicine and Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Marc Corbière
- Department of Education, Career Counselling, Université du Québec à Montréal, Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - David J. A. Dozois
- Department of Psychology, University of Western Ontario, London, ON, Canada
| | - Jeff Habert
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - John Harrison
- Metis Cognition Ltd., Kilmington, United Kingdom; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, United Kingdom; Alzheimercentrum, AUmc, Amsterdam, Netherlands
| | - Martin A. Katzman
- START Clinic for the Mood and Anxiety Disorders, Toronto, ON, Canada; Department of Psychiatry, Northern Ontario School of Medicine, and Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Roger S. McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yang S. Liu
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Karen Nieuwenhuijsen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Carolyn S. Dewa
- Department of Psychiatry and Behavioural Sciences, University of California, Davis, Davis, CA, United States
| |
Collapse
|
20
|
Uhlig L, Baumgartner V, Prem R, Siestrup K, Korunka C, Kubicek B. A field experiment on the effects of weekly planning behaviour on work engagement, unfinished tasks, rumination, and cognitive flexibility. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2023; 96:575-598. [PMID: 38515981 PMCID: PMC10952538 DOI: 10.1111/joop.12430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 03/23/2024]
Abstract
This study concerns research on self-regulation. It examines the effects of planning behaviour, a comprehensive self-regulatory strategy of goal setting, planning work steps, and developing alternative plans. Combining different strategies, rather than testing them in isolation, would strengthen their effects and make them more appropriate for complex work tasks. Drawing on self-regulation theory, we propose that planning behaviour positively affects work engagement, unfinished tasks, rumination, and cognitive flexibility. Considering cognitive flexibility as an outcome provides insight into the cognitive benefits of planning behaviour. We examine person-level cognitive demands of flexible work and predictability as moderator variables to better understand the role of contextual variables in the use of self-regulatory strategies at work. We conducted a field experiment (N = 208 individuals; 947 weekly entries) in which we manipulated employees' weekly planning behaviour in their daily work lives. We found negative effects on unfinished tasks and weekly rumination, and positive effects on weekly cognitive flexibility. No significant moderating effects were found. Our study suggests that a brief planning manipulation at the beginning of the week may have multiple benefits and may be an important tool for improving cognitive flexibility. Future research should examine the role of time and mediating variables.
Collapse
Affiliation(s)
- Lars Uhlig
- Institute of PsychologyUniversity of GrazGrazAustria
- Faculty of PsychologyUniversity of ViennaViennaAustria
| | | | - Roman Prem
- Institute of PsychologyUniversity of GrazGrazAustria
| | - Katja Siestrup
- Department of Work and Organizational Psychology, Faculty of PsychologyFernUniversität in HagenHagenGermany
| | | | | |
Collapse
|
21
|
Harding AB, Ramirez MR, Ryan AD, Xiong BN, Rosebush CE, Woods-Jaeger B. Impacts of COVID-19 on Stress in Middle School Teachers and Staff in Minnesota: An Exploratory Study Using Random Forest Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6698. [PMID: 37681838 PMCID: PMC10487626 DOI: 10.3390/ijerph20176698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
While the COVID-19 pandemic has negatively impacted many occupations, teachers and school staff have faced unique challenges related to remote and hybrid teaching, less contact with students, and general uncertainty. This study aimed to measure the associations between specific impacts of the COVID-19 pandemic and stress levels in Minnesota educators. A total of 296 teachers and staff members from eight middle schools completed online surveys between May and July of 2020. The Epidemic Pandemic Impacts Inventory (EPII) measured the effects of the COVID-19 pandemic according to nine domains (i.e., Economic, Home Life). The Kessler-6 scale measured non-specific stress (range: 0-24), with higher scores indicating greater levels of stress. Random forest analysis determined which items of the EPII were predictive of stress. The average Kessler-6 score was 6.8, indicating moderate stress. Three EPII items explained the largest amount of variation in the Kessler-6 score: increase in mental health problems or symptoms, hard time making the transition to working from home, and increase in sleep problems or poor sleep quality. These findings indicate potential areas for intervention to reduce employee stress in the event of future disruptions to in-person teaching or other major transitions during dynamic times.
Collapse
Affiliation(s)
- Alyson B. Harding
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA; (M.R.R.); (A.D.R.); (B.N.X.)
| | - Marizen R. Ramirez
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA; (M.R.R.); (A.D.R.); (B.N.X.)
- Department of Environmental and Occupational Health, Program of Public Health, University of California at Irvine, Irvina, CA 92697, USA
| | - Andrew D. Ryan
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA; (M.R.R.); (A.D.R.); (B.N.X.)
| | - Bao Nhia Xiong
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA; (M.R.R.); (A.D.R.); (B.N.X.)
| | - Christina E. Rosebush
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA; (M.R.R.); (A.D.R.); (B.N.X.)
| | - Briana Woods-Jaeger
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| |
Collapse
|
22
|
Germain A, Wolfson M, Pulantara IW, Wallace ML, Nugent K, Mesias G, Clarke-Walper K, Quartana PJ, Wilk J. Prototyping Apps for the Management of Sleep, Fatigue, and Behavioral Health in Austere Far-Forward Environments: Development Study. J Med Internet Res 2023; 25:e40640. [PMID: 37639304 PMCID: PMC10495854 DOI: 10.2196/40640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Military service inherently includes frequent periods of high-stress training, operational tempo, and sustained deployments to austere far-forward environments. These occupational requirements can contribute to acute and chronic sleep disruption, fatigue, and behavioral health challenges related to acute and chronic stress and disruption of team dynamics. To date, there is no centralized mobile health platform that supports self- and supervised detection, monitoring, and management of sleep and behavioral health issues in garrison and during and after deployments. OBJECTIVE The objective of this study was to adapt a clinical decision support platform for use outside clinical settings, in garrison, and during field exercises by medics and soldiers to monitor and manage sleep and behavioral health in operational settings. METHODS To adapt an existing clinical decision support digital health platform, we first gathered system, content, and context-related requirements for a sleep and behavioral health management system from experts. Sleep and behavioral health assessments were then adapted for prospective digital data capture. Evidence-based and operationally relevant educational and interventional modules were formatted for digital delivery. These modules addressed the management and mitigation of sleep, circadian challenges, fatigue, stress responses, and team communication. Connectivity protocols were adapted to accommodate the absence of cellular or Wi-Fi access in deployed settings. The resulting apps were then tested in garrison and during 2 separate field exercises. RESULTS Based on identified requirements, 2 Android smartphone apps were adapted for self-monitoring and management for soldiers (Soldier app) and team supervision and intervention by medics (Medic app). A total of 246 soldiers, including 28 medics, received training on how to use the apps. Both apps function as expected under conditions of limited connectivity during field exercises. Areas for future technology enhancement were also identified. CONCLUSIONS We demonstrated the feasibility of adapting a clinical decision support platform into Android smartphone-based apps to collect, save, and synthesize sleep and behavioral health data, as well as share data using adaptive data transfer protocols when Wi-Fi or cellular data are unavailable. The AIRE (Autonomous Connectivity Independent System for Remote Environments) prototype offers a novel self-management and supervised tool to augment capabilities for prospective monitoring, detection, and intervention for emerging sleep, fatigue, and behavioral health issues that are common in military and nonmilitary high-tempo occupations (eg, submarines, long-haul flights, space stations, and oil rigs) where medical expertise is limited.
Collapse
Affiliation(s)
| | | | | | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Katie Nugent
- Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, Silver Spring, MD, United States
- TechWerks, LLC, Silver Spring, MD, United States
| | - George Mesias
- Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Kristina Clarke-Walper
- Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Phillip J Quartana
- Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Joshua Wilk
- Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| |
Collapse
|
23
|
Deady M, Collins DAJ, Lavender I, Mackinnon A, Glozier N, Bryant R, Christensen H, Harvey SB. Selective Prevention of Depression in Workers Using a Smartphone App: Randomized Controlled Trial. J Med Internet Res 2023; 25:e45963. [PMID: 37616040 PMCID: PMC10485707 DOI: 10.2196/45963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/27/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND There is increasing evidence that depression can be prevented; however, universal approaches have had limited success. Appropriate targeting of interventions to at-risk populations has been shown to have potential, but how to selectively determine at-risk individuals remains unclear. Workplace stress is a risk factor for depression and a target for intervention, but few interventions exist to prevent depression among workers at risk due to heightened stress. OBJECTIVE This trial aimed to evaluate the efficacy of a smartphone-based intervention in reducing the onset of depression and improving related outcomes in workers experiencing at least moderate levels of stress. METHODS A randomized controlled trial was conducted with participants who were currently employed and reported no clinically significant depression and at least moderate stress. The intervention group (n=1053) were assigned Anchored, a 30-day self-directed smartphone app-based cognitive behavioral- and mindfulness-based intervention. The attention-control group (n=1031) were assigned a psychoeducation website. Assessment was performed via web-based self-report questionnaires at baseline and at 1-, 3-, and 6-month postbaseline time points. The primary outcome was new depression caseness aggregated over the follow-up period. The secondary outcomes included depressive and anxiety symptoms, stress, well-being, resilience, work performance, work-related burnout, and quality of life. Analyses were conducted within an intention-to-treat framework using mixed modeling. RESULTS There was no significant between-group difference in new depression caseness (z score=0.69; P=.49); however, those in the Anchored arm had significantly greater depressive symptom reduction at 1 month (Cohen d=0.02; P=.049) and 6 months (Cohen d=0.08; P=.03). Anchored participants also showed significantly greater reduction in anxiety symptoms at 1 month (Cohen d=0.07; P=.04) and increased work performance at 1 month (Cohen d=0.07; P=.008) and 6 months (Cohen d=0.13; P=.01), compared with controls. Notably, for Anchored participants completing at least two-thirds of the intervention, there was a significantly lower rate of depression onset (1.1%, 95% CI 0.0%-3.7%) compared with controls (9.0%, 95% CI 6.8%-12.3%) at 1 month (z score=4.50; P<.001). Significant small to medium effect sizes for most secondary outcomes were seen in the highly engaged Anchored users compared with controls, with effects maintained at the 6-month follow-up for depressive symptoms, well-being, stress, and quality of life. CONCLUSIONS Anchored was associated with a small comparative reduction in depressive symptoms compared with controls, although selective prevention of case-level depression was not observed in the intention-to-treat analysis. When users adequately engaged with the app, significant findings pertaining to depression prevention, overall symptom reduction, and functional improvement were found, compared with controls. There is a need for a greater focus on engagement techniques in future research. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000178943; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378592.
Collapse
Affiliation(s)
- Mark Deady
- Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Randwick, Australia
| | - Daniel A J Collins
- Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Randwick, Australia
| | - Isobel Lavender
- Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Randwick, Australia
| | - Andrew Mackinnon
- Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Randwick, Australia
| | - Nicholas Glozier
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Helen Christensen
- Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Randwick, Australia
| | - Samuel B Harvey
- Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Randwick, Australia
| |
Collapse
|
24
|
Ito-Masui A, Sakamoto R, Matsuo E, Kawamoto E, Motomura E, Tanii H, Yu H, Sano A, Imai H, Shimaoka M. Effect of an Internet-Delivered Cognitive Behavioral Therapy-Based Sleep Improvement App for Shift Workers at High Risk of Sleep Disorder: Single-Arm, Nonrandomized Trial. J Med Internet Res 2023; 25:e45834. [PMID: 37606971 PMCID: PMC10481224 DOI: 10.2196/45834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/02/2023] [Accepted: 07/04/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Shift workers are at high risk of developing sleep disorders such as shift worker sleep disorder or chronic insomnia. Cognitive behavioral therapy (CBT) is the first-line treatment for insomnia, and emerging evidence shows that internet-based CBT is highly effective with additional features such as continuous tracking and personalization. However, there are limited studies on internet-based CBT for shift workers with sleep disorders. OBJECTIVE This study aimed to evaluate the impact of a 4-week, physician-assisted, internet-delivered CBT program incorporating machine learning-based well-being prediction on the sleep duration of shift workers at high risk of sleep disorders. We evaluated these outcomes using an internet-delivered CBT app and fitness trackers in the intensive care unit. METHODS A convenience sample of 61 shift workers (mean age 32.9, SD 8.3 years) from the intensive care unit or emergency department participated in the study. Eligible participants were on a 3-shift schedule and had a Pittsburgh Sleep Quality Index score ≥5. The study comprised a 1-week baseline period, followed by a 4-week intervention period. Before the study, the participants completed questionnaires regarding the subjective evaluation of sleep, burnout syndrome, and mental health. Participants were asked to wear a commercial fitness tracker to track their daily activities, heart rate, and sleep for 5 weeks. The internet-delivered CBT program included well-being prediction, activity and sleep chart, and sleep advice. A job-based multitask and multilabel convolutional neural network-based model was used for well-being prediction. Participant-specific sleep advice was provided by sleep physicians based on daily surveys and fitness tracker data. The primary end point of this study was sleep duration. For continuous measurements (sleep duration, steps, etc), the mean baseline and week-4 intervention data were compared. The 2-tailed paired t test or Wilcoxon signed rank test was performed depending on the distribution of the data. RESULTS In the fourth week of intervention, the mean daily sleep duration for 7 days (6.06, SD 1.30 hours) showed a statistically significant increase compared with the baseline (5.54, SD 1.36 hours; P=.02). Subjective sleep quality, as measured by the Pittsburgh Sleep Quality Index, also showed statistically significant improvement from baseline (9.10) to after the intervention (7.84; P=.001). However, no significant improvement was found in the subjective well-being scores (all P>.05). Feature importance analysis for all 45 variables in the prediction model showed that sleep duration had the highest importance. CONCLUSIONS The physician-assisted internet-delivered CBT program targeting shift workers with a high risk of sleep disorders showed a statistically significant increase in sleep duration as measured by wearable sensors along with subjective sleep quality. This study shows that sleep improvement programs using an app and wearable sensors are feasible and may play an important role in preventing shift work-related sleep disorders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/24799.
Collapse
Affiliation(s)
- Asami Ito-Masui
- Emergency and Critical Care Center, Mie University, Tsu, Japan
| | - Ryota Sakamoto
- Department of Medical Informatics, Mie University Hospital, Tsu, Japan
| | - Eri Matsuo
- Department of Molecular Pathology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eiji Kawamoto
- Emergency and Critical Care Center, Mie University, Tsu, Japan
| | - Eishi Motomura
- Department of Neuropsychiatry, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hisashi Tanii
- Center for Physical & Mental Health, Mie University, Tsu, Japan
| | - Han Yu
- Department of Electrical & Computer Engineering, Rice University, Houston, TX, United States
| | - Akane Sano
- Department of Electrical & Computer Engineering, Rice University, Houston, TX, United States
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University, Tsu, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
| |
Collapse
|
25
|
Dreer B. On the outcomes of teacher wellbeing: a systematic review of research. Front Psychol 2023; 14:1205179. [PMID: 37575417 PMCID: PMC10421665 DOI: 10.3389/fpsyg.2023.1205179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Teacher wellbeing is a growing area of research that has seen a steady increase in publications in recent years. The subsequent need to synthesize and structure this existing research has been articulated and addressed by a handful of systematic research reviews. However, no previous reviews have examined the potential outcomes of teacher wellbeing as a primary theme. Methods Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, this review has identified and evaluated the studies investigating the possible outcomes of teacher wellbeing. A keyword search identified 397 records. After the records were screened, 44 research studies analyzing data from over 76,990 teachers were included in this in-depth analysis; the concepts, methods and findings of these studies were examined. Results and discussion The results of this review highlight the significant relationship of teacher wellbeing with several factors and desirable outcomes, including teachers' sleep quality, teacher retention, teacher-student relationships, and student outcomes. However, only a few of the included studies employed methodologies that support causal interpretations of these effects. In light of the present findings, this paper offers three main recommendations to support future progress in this field.
Collapse
Affiliation(s)
- Benjamin Dreer
- Erfurt School of Education, University of Erfurt, Erfurt, Germany
| |
Collapse
|
26
|
Cohen C, Pignata S, Bezak E, Tie M, Childs J. Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: a systematic review. BMJ Open 2023; 13:e071203. [PMID: 37385740 PMCID: PMC10314589 DOI: 10.1136/bmjopen-2022-071203] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/23/2023] [Indexed: 07/01/2023] Open
Abstract
There is a growing need for interventions to improve well-being in healthcare workers, particularly since the onset of COVID-19. OBJECTIVES To synthesise evidence since 2015 on the impact of interventions designed to address well-being and burnout in physicians, nurses and allied healthcare professionals. DESIGN Systematic literature review. DATA SOURCES Medline, Embase, Emcare, CINAHL, PsycInfo and Google Scholar were searched in May-October 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that primarily investigated burnout and/or well-being and reported quantifiable preintervention and postintervention outcomes using validated well-being measures were included. DATA EXTRACTION AND SYNTHESIS Full-text articles in English were independently screened and quality assessed by two researchers using the Medical Education Research Study Quality Instrument. Results were synthesised and presented in both quantitative and narrative formats. Meta-analysis was not possible due to variations in study designs and outcomes. RESULTS A total of 1663 articles were screened for eligibility, with 33 meeting inclusion criterium. Thirty studies used individually focused interventions, while three were organisationally focused. Thirty-one studies used secondary level interventions (managed stress in individuals) and two were primary level (eliminated stress causes). Mindfulness-based practices were adopted in 20 studies; the remainder used meditation, yoga and acupuncture. Other interventions promoted a positive mindset (gratitude journaling, choirs, coaching) while organisational interventions centred on workload reduction, job crafting and peer networks. Effective outcomes were reported in 29 studies, with significant improvements in well-being, work engagement, quality of life and resilience, and reductions in burnout, perceived stress, anxiety and depression. CONCLUSION The review found that interventions benefitted healthcare workers by increasing well-being, engagement and resilience, and reducing burnout. It is noted that the outcomes of numerous studies were impacted by design limitations that is, no control/waitlist control, and/or no post intervention follow-up. Suggestions are made for future research.
Collapse
Affiliation(s)
- Catherine Cohen
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Silvia Pignata
- STEM, University of South Australia, Adelaide, South Australia, Australia
| | - Eva Bezak
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Mark Tie
- Australian Radiology Clinics, Adelaide, South Australia, Australia
| | - Jessie Childs
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
27
|
Taylor RW, Male R, Economides M, Bolton H, Cavanagh K. Feasibility and Preliminary Efficacy of Digital Interventions for Depressive Symptoms in Working Adults: Multiarm Randomized Controlled Trial. JMIR Form Res 2023; 7:e41590. [PMID: 37327027 DOI: 10.2196/41590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/02/2023] [Accepted: 04/14/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Depressive symptoms are highly prevalent and have broad-ranging negative implications. Digital interventions are increasingly available in the workplace context, but supporting evidence is limited. OBJECTIVE This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of 3 digital interventions for depressive symptoms in a sample of UK-based working adults experiencing mild to moderate symptoms. METHODS This was a parallel, multiarm, pilot randomized controlled trial. Participants were allocated to 1 of 3 digital interventions or a waitlist control group and had 3 weeks to complete 6 to 8 short self-guided sessions. The 3 interventions are available on the Unmind mental health app for working adults and draw on behavioral activation, cognitive behavioral therapy, and acceptance and commitment therapy. Web-based assessments were conducted at baseline, postintervention (week 3), and at 1-month follow-up (week 7). Participants were recruited via Prolific, a web-based recruitment platform, and the study was conducted entirely on the web. Feasibility and acceptability were assessed using objective engagement data and self-reported feedback. Efficacy outcomes were assessed using validated self-report measures of mental health and functioning and linear mixed models with intention-to-treat principles. RESULTS In total, 2003 individuals were screened for participation, of which 20.22% (405/2003) were randomized. A total of 92% (373/405) of the participants were retained in the study, 97.4% (295/303) initiated their allocated intervention, and 66.3% (201/303) completed all sessions. Moreover, 80.6% (229/284) of the participants rated the quality of their allocated intervention as excellent or good, and 79.6% (226/284) of the participants were satisfied or very satisfied with their intervention. All active groups showed improvements in well-being, functioning, and depressive and anxiety symptoms compared with the control group, which were maintained at 4 weeks. Hedges g effect sizes for depressive symptoms ranged from -0.53 (95% CI -0.25 to -0.81) to -0.74 (95% CI -0.45 to -1.03). CONCLUSIONS All interventions were feasible and acceptable, and the preliminary efficacy findings indicated that their use may improve depressive symptoms, well-being, and functioning. The predefined criteria for a definitive trial were met. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number (ISRCTN) ISRCTN13067492; https://www.isrctn.com/ISRCTN13067492.
Collapse
|
28
|
Hogg B, Moreno-Alcázar A, Tóth MD, Serbanescu I, Aust B, Leduc C, Paterson C, Tsantilla F, Abdulla K, Cerga-Pashoja A, Cresswell-Smith J, Fanaj N, Meksi A, Ni Dhalaigh D, Reich H, Ross V, Sanches S, Thomson K, Van Audenhove C, Pérez V, Arensman E, Purebl G, Amann BL. Supporting employees with mental illness and reducing mental illness-related stigma in the workplace: an expert survey. Eur Arch Psychiatry Clin Neurosci 2023; 273:739-753. [PMID: 35867155 PMCID: PMC9305029 DOI: 10.1007/s00406-022-01443-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/29/2022] [Indexed: 11/28/2022]
Abstract
An expert survey was designed to support the development of a workplace-based multi-country intervention tackling depression, anxiety, and mental illness-related stigma in small- and medium-sized enterprises (SMEs). Academic experts and representatives of SME organisations, specific sector organisations, labour or advocacy groups, and occupational health organisations, were contacted across eight European countries and Australia. The survey comprised closed and open text questions to assess expert opinion about interventions for employees with mental health difficulties, interventions supporting their managers, and anti-stigma interventions. The survey was available in six languages. The online platform Qualtrics was used for data collection. Quantitative data was analysed through descriptive statistics and qualitative data was analysed through thematic analysis. Sixty-five of 146 experts responded, representing a 42% response rate. Results showed only 26.2% of experts agreed that employees could speak openly about mental health issues, and 81.5% of experts indicated a large or medium unmet need for support for employees with mental health issues. Psychoeducational materials, face-to-face workshops and interventions based on cognitive behavioural therapy were ranked most likely to be taken up by employees. Experts rated as most useful for managers' guidelines on how to act if an employee has mental health issues (67.7%). The greatest number of experts indicated workshops of people with lived experience of mental illness (80.0%) and awareness campaigns (78.5%) were most required to tackle stigma. Responses were consistent between experts from different countries and areas of expertise. Experts in this multinational survey assessed that interventions supporting mental health in the workplace and tackling stigma are greatly needed. A multicomponent intervention with a wide range of materials and tools is supported.
Collapse
Affiliation(s)
- Bridget Hogg
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- PhD Programme, Dept. of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Moreno-Alcázar
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Mónika Ditta Tóth
- Institute of Behavioural Sciences, Semmelweis University, Semmelweis Egyetem Magatartástudományi Intézet, Budapest, Hungary
| | - Ilinca Serbanescu
- Faculty of Psychology and Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Birgit Aust
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Caleb Leduc
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - Charlotte Paterson
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, Scotland
| | - Fotini Tsantilla
- LUCAS, Center for Care Research and Consultancy, Faculty of Medicine, KU Leuven, Louvain, Belgium
| | - Kahar Abdulla
- European Alliance Against Depression E.V, Leipzig, Germany
| | - Arlinda Cerga-Pashoja
- Population Health, London School of Hygiene and Tropical Medicine, London, England
- Global Public Health, Public Health England, Greenwich, UK
| | | | | | | | | | - Hanna Reich
- Depression Research Centre of the German Depression Foundation, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt am Main, Germany
- German Depression Foundation, Leipzig, Germany
| | - Victoria Ross
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Qld, Australia
| | - Sarita Sanches
- Phrenos Center of Expertise for Severe Mental Illness, Utrecht, the Netherlands
| | - Katherine Thomson
- International Association for Suicide Prevention (IASP), Washington, DC, USA
| | - Chantal Van Audenhove
- LUCAS, Center for Care Research and Consultancy, Faculty of Medicine, KU Leuven, Louvain, Belgium
| | - Victor Pérez
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Dept. of Psychiatry and Forensic Medicine, Pompeu Fabra University, Barcelona, Spain
| | - Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Qld, Australia
- International Association for Suicide Prevention (IASP), Washington, DC, USA
| | - Gyorgy Purebl
- Institute of Behavioural Sciences, Semmelweis University, Semmelweis Egyetem Magatartástudományi Intézet, Budapest, Hungary.
| | - Benedikt L Amann
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Dept. of Psychiatry and Forensic Medicine, Pompeu Fabra University, Barcelona, Spain
- Dept. of Psychiatry and Psychotherapy, Ludwig Maximilian University Hospital Munich, Nussbaumstraße 7, Munich, Germany
| |
Collapse
|
29
|
Miguel C, Amarnath A, Akhtar A, Malik A, Baranyi G, Barbui C, Karyotaki E, Cuijpers P. Universal, selective and indicated interventions for supporting mental health at the workplace: an umbrella review of meta-analyses. Occup Environ Med 2023; 80:225-236. [PMID: 36828633 PMCID: PMC10086469 DOI: 10.1136/oemed-2022-108698] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/19/2023] [Indexed: 02/26/2023]
Abstract
The current umbrella review aimed to assess and summarise evidence on universal, selective and indicated interventions for mental health at the workplace. This umbrella review forms one of the evidence reviews which were commissioned by the WHO to develop global guidelines on mental health at work. We conducted systematic searches in five bibliographic databases (PubMed, Embase, PsycINFO, Cochrane and Global Medicus Index) and included meta-analyses of randomised trials examining psychosocial, physical activity and lifestyle interventions delivered to all general workers (universal interventions), at-risk workers (selective interventions) and workers already experiencing symptoms of mental disorders (indicated interventions). We included outcomes from seven domains: symptoms of mental health conditions, positive mental health, quality of life, work-related outcomes, substance use, suicide-related outcomes and potential adverse effects. We identified 16 meta-analyses producing 66 pooled effect sizes of the examined interventions, mostly on symptoms of mental health conditions (n=43 pooled effect sizes) (eg, burnout, insomnia, stress) and positive mental health (n=15) (eg, well-being). Most of the evidence on universal, selective and indicated interventions was focused on psychosocial interventions, showing small to moderate effects across the various outcomes. Certainty levels according to GRADE (Grading of Recommendations Assessment, Development and Evaluation) were low to very low in almost all of the examined outcomes. The results of existing meta-analyses are promising for the use of preventative and early treatment interventions in the workplace. However, the quality and certainty of the evidence were very modest, and further research on the effectiveness of these interventions is warranted.
Collapse
Affiliation(s)
- Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arpana Amarnath
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Aiysha Malik
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Gergő Baranyi
- Society and Health, The University of Edinburgh, Edinburgh, UK
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
30
|
Radin RM, Epel ES, Mason AE, Vaccaro J, Fromer E, Guan J, Prather AA. Impact of digital meditation on work stress and health outcomes among adults with overweight: A randomized controlled trial. PLoS One 2023; 18:e0280808. [PMID: 36857330 PMCID: PMC9977041 DOI: 10.1371/journal.pone.0280808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 12/16/2022] [Indexed: 03/02/2023] Open
Abstract
Mindfulness meditation may improve well-being at work; however, effects on food cravings and metabolic health are not well known. We tested effects of digital meditation, alone or in combination with a healthy eating program, on perceived stress, cravings, and adiposity. We randomized 161 participants with overweight and moderate stress to digital meditation ('MED,' n = 38), digital meditation + healthy eating ('MED+HE,' n = 40), active control ('HE,' n = 41), or waitlist control ('WL,' n = 42) for 8 weeks. Participants (n = 145; M(SD) BMI: 30.8 (5.4) kg/m2) completed baseline and 8-week measures of stress (Perceived Stress Scale), cravings (Food Acceptance and Awareness Questionnaire) and adiposity (sagittal diameter and BMI). ANCOVAs revealed that those randomized to MED or MED+HE (vs. HE or WL) showed decreases in perceived stress (F = 15.19, p < .001, η2 = .10) and sagittal diameter (F = 4.59, p = .03, η2 = .04), with no differences in cravings or BMI. Those high in binge eating who received MED or MED+HE showed decreases in sagittal diameter (p = .03). Those with greater adherence to MED or MED+HE had greater reductions in stress, cravings, and adiposity (ps < .05). A brief digital mindfulness-based program is a low-cost method for reducing perceptions of stress and improving abdominal fat distribution patterns among adults with overweight and moderate stress. Future work should seek to clarify mechanisms by which such interventions contribute to improvements in health. Trial registration: Clinical trial registration http://www.ClinicalTrials.gov: identifier NCT03945214.
Collapse
Affiliation(s)
- Rachel M. Radin
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Elissa S. Epel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Ashley E. Mason
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Julie Vaccaro
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Elena Fromer
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Joanna Guan
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Aric A. Prather
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| |
Collapse
|
31
|
Sasaki N, Imamura K, Nishi D, Watanabe K, Asaoka H, Sekiya Y, Tsuno K, Kobayashi Y, Obikane E, Kawakami N. The effect of internet-based acceptance and commitment therapy (iACT) on psychological well-being among working women with a pre-school child: A randomized controlled trial. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
|
32
|
Meischke H, Rogers M, Manchanda S, Sears JM, Revere D, Grewal R, Beaton R. Development and Evaluation of an Online Toolkit for Managers of 9-1-1 Emergency Communications Centers to Reduce Occupational Stress. Health Promot Pract 2023; 24:360-365. [PMID: 34605712 DOI: 10.1177/15248399211042332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes the development and evaluation of an online workplace stress reduction toolkit for use by managers of 9-1-1 emergency communication centers (ECCs). A three-step process for development and testing of digital learning resources was used: (1) establishing need and focus through ECC manager stakeholder engagement, (2) pretesting of the toolkit with the target ECC manager audience, and (3) toolkit utilization and evaluation. The toolkit was developed in close partnership with stakeholders throughout the entire process. Toolkit usage was documented via registration data. The evaluation utilized an online survey that included closed and open-ended questions, which were analyzed using descriptive statistics and qualitative thematic analysis. Over a 20-month period, 274 people registered for the toolkit and, of those, 184 (67%) accessed the content. Respondents to the evaluation survey (N = 156) scored the toolkit highly on satisfaction, self-efficacy, and perceived utility measures. Survey respondents reported intent to apply toolkit content through the following: providing organizational resources to help workers take better care of themselves (41%); creating a lower stress worksite environment (35%) and sharing resources with staff to (1) reduce stress (19%), (2) support conflict resolution (21%), and (3) prevent and/or stop bullying (17%). In delivering actionable content to ECC managers, the toolkit shows promise in addressing and mitigating occupational stress in ECCs. Further research needs to determine the relationship of this strategy for reducing ECC stress.
Collapse
|
33
|
Stratton E, Player MJ, Glozier N. Online mental health training program for male-dominated organisations: a pre-post pilot study assessing feasibility, usability, and preliminary effectiveness. Int Arch Occup Environ Health 2023; 96:641-649. [PMID: 36800032 DOI: 10.1007/s00420-023-01961-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE The emergence of digital health interventions for mental ill-health in the workplace is expansive. Digital interventions delivered in male-dominated settings are less so. This pilot study aimed to assess the usability, feasibility, acceptability, and preliminary effects of an online intervention in a male-dominated organization. We focus on male-dominated as mental ill-health is frequently unrecognized and underdiagnosed among males. METHODS Unwind, a 7-week internet-based program with stress-management components, was tested in a pre-post pilot study. Unwind gets users to identify and understand their stress triggers and assists them to develop adaptive ways to manage these and their stress. Participants were Australian adults employed in a mining company. Follow-up assessment occurred 8 weeks after baseline. The primary outcome measure was change in stress symptoms, with secondary outcomes; change in depression, anxiety, insomnia, well-being, and alcohol use. User feedback and program data were analyzed to assess usability, engagement, and intervention adherence. RESULTS Eligible participants n = 87 showed significant reductions in stress (g = 0.46, p < 0.001), depression (g = 0.47, p < 0.001), anxiety (g = 0.50, p < 0.001), insomnia (g = 0.44, p < 0.001), and well-being (g = 0.32, p = 0.004) post-intervention. Significant improvements were observed in both well and unwell (mental ill-health) and male and female participants. There was no gender effect on outcomes. A dose-response was observed as the number of modules used was related positively to improvement in anxiety (F1,86 = 5.735, p = 0.019; R2 = 0.25). Overall users rated Unwind as useful and engaging. CONCLUSION This study presents evidence base that Unwind is a feasible and acceptable approach to reducing employees' mental health-related symptoms in typically difficult-to-reach male-dominated industries. Unwind is feasible for larger scale delivery within male-dominated industries.
Collapse
Affiliation(s)
- Elizabeth Stratton
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Office 8, Lvl 5, Professor Marie Bashir Building, Missenden Road, Camperdown, NSW, 2006, Australia. .,ARC Centre of Excellence for Children and Families Over the Life Course, University of Sydney, Office 8, Lvl 5, Professor Marie Bashir Building, Missenden Road, Camperdown, NSW, 2006, Australia.
| | - Michael J Player
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Office 8, Lvl 5, Professor Marie Bashir Building, Missenden Road, Camperdown, NSW, 2006, Australia
| | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Office 8, Lvl 5, Professor Marie Bashir Building, Missenden Road, Camperdown, NSW, 2006, Australia.,ARC Centre of Excellence for Children and Families Over the Life Course, University of Sydney, Office 8, Lvl 5, Professor Marie Bashir Building, Missenden Road, Camperdown, NSW, 2006, Australia
| |
Collapse
|
34
|
Dias RDL, Shalaby R, Agyapong B, Obuobi-Donkor G, Adu MK, Eboreime E, Obeng Nkrumah S, Sridharan S, Simon P, Taylor B, Henderson N, White MD, Maguire H, Gray G, Rahman F, Fair J, Wadden N, Sulyman M, Williams O, Akinkunmi O, Edem D, Arenella P, Morrison J, Awara M, Natarajan A, Nunes A, Hajek T, O’Donavan C, Uher R, Wang J, Rusak B, Wozney L, Sampalli T, Grant D, Tomblin Murphy G, Warford J, Hodder S, Boe R, Agyapong VIO. Augmenting Mental Health Support for Patients Accessing Different Degrees of Formal Psychiatric Care through a Supportive Text Messaging Program: Protocol for a Randomized Controlled Trial. Methods Protoc 2023; 6:mps6010019. [PMID: 36827506 PMCID: PMC9959317 DOI: 10.3390/mps6010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/23/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Patients feel more vulnerable when accessing community mental health programs for the first time or after being discharged from psychiatric inpatient units. Long wait times for follow-up appointments, shortage of mental health professionals, lack of service integration, and scarcity of tailored support can weaken their connection to the health care system. As a result, patients can present low adherence, dissatisfaction with treatment, and recurrent hospitalizations. Finding solutions to avoid unnecessary high-cost services and providing tailored and cost-effective mental health interventions may reduce the health system burden and augment patient support. We propose implementing an add-on, supportive text messaging service (Text4Support), developed using cognitive-behavioural therapy (CBT) principles to augment mental health support for patients attending to or being discharged from psychiatric care in Nova Scotia, Canada. This randomized controlled trial aims to investigate the effectiveness of Text4Support in improving mental health outcomes and overall mental well-being compared with usual care. We also will examine the intervention's impact on health services utilization and patient satisfaction. The results from this study will provide evidence on stepped and technology-based mental health care, which will contribute to generating new knowledge about mental health innovations in various clinical contexts, which is not only helpful for the local context but to other jurisdictions in Canada and abroad that are seeking to improve their health care.
Collapse
Affiliation(s)
- Raquel da Luz Dias
- Department of Psychiatry, Nova Scotia Health, Halifax, NS B3H 2E2, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Belinda Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Gloria Obuobi-Donkor
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Medard K. Adu
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | | | - Sanjana Sridharan
- Department of Psychiatry, Nova Scotia Health, Halifax, NS B3H 2E2, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Patryk Simon
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Bryanne Taylor
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Neal Henderson
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Mathew D. White
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Hugh Maguire
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Gerald Gray
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Faisal Rahman
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Janah Fair
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Nadine Wadden
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Mutiat Sulyman
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Olugbenga Williams
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Oluseye Akinkunmi
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Dorothy Edem
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Pamela Arenella
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Jason Morrison
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Mahmoud Awara
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Anand Natarajan
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Abraham Nunes
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Tomas Hajek
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Claire O’Donavan
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Rudolf Uher
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - JianLi Wang
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Nova Scotia Health Innovation Hub, Halifax, NS B3S 0H6, Canada
| | - Benjamin Rusak
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Lori Wozney
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Mental Health and Addictions Program, IWK Health, Halifax, NS B3K 6R8, Canada
| | - Tara Sampalli
- Nova Scotia Health Innovation Hub, Halifax, NS B3S 0H6, Canada
| | - Doris Grant
- Nova Scotia Health Innovation Hub, Halifax, NS B3S 0H6, Canada
| | | | - Jordan Warford
- Nova Scotia Health Innovation Hub, Halifax, NS B3S 0H6, Canada
| | - Samantha Hodder
- School of Nursing, Cape Breton University, Cape Breton, NS B1M 1A2, Canada
| | - Rachel Boe
- Addictions and Mental Health, Horizon Health Network, Fredericton, NB E3B 4R3, Canada
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, Nova Scotia Health, Halifax, NS B3H 2E2, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Correspondence: or
| |
Collapse
|
35
|
Gnanapragasam SN, Tinch-Taylor R, Scott HR, Hegarty S, Souliou E, Bhundia R, Lamb D, Weston D, Greenberg N, Madan I, Stevelink S, Raine R, Carter B, Wessely S. Multicentre, England-wide randomised controlled trial of the 'Foundations' smartphone application in improving mental health and well-being in a healthcare worker population. Br J Psychiatry 2023; 222:58-66. [PMID: 36040419 PMCID: PMC10895508 DOI: 10.1192/bjp.2022.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Healthcare workers (HCWs) have faced considerable pressures during the COVID-19 pandemic. For some, this has resulted in mental health distress and disorder. Although interventions have sought to support HCWs, few have been evaluated. AIMS We aimed to determine the effectiveness of the 'Foundations' application (app) on general (non-psychotic) psychiatric morbidity. METHOD We conducted a multicentre randomised controlled trial of HCWs at 16 NHS trusts (trial registration number: EudraCT: 2021-001279-18). Participants were randomly assigned to the app or wait-list control group. Measures were assessed at baseline, after 4 and 8 weeks. The primary outcome was general psychiatric morbidity (using the General Health Questionnaire). Secondary outcomes included: well-being; presenteeism; anxiety; depression and insomnia. The primary analysis used mixed-effects multivariable regression, presented as adjusted mean differences (aMD). RESULTS Between 22 March and 3 June 2021, 1002 participants were randomised (500:502), and 894 (89.2%) followed-up. The sample was predominately women (754/894, 84.3%), with a mean age of 44⋅3 years (interquartile range (IQR) 34-53). Participants randomised to the app had a reduction in psychiatric morbidity symptoms (aMD = -1.39, 95% CI -2.05 to -0.74), improvement in well-being (aMD = 0⋅54, 95% CI 0⋅20 to 0⋅89) and reduction in insomnia (adjusted odds ratio (aOR) = 0⋅36, 95% CI 0⋅21 to 0⋅60). No other significant findings were found, or adverse events reported. CONCLUSIONS The app had an effect in reducing psychiatric morbidity symptoms in a sample of HCWs. Given it is scalable with no adverse effects, the app may be used as part of an organisation's tiered staff support package. Further evidence is needed on long-term effectiveness and cost-effectiveness.
Collapse
Affiliation(s)
- Sam N. Gnanapragasam
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK and South London and Maudsley NHS Foundation Trust, UK
| | - Rose Tinch-Taylor
- Department of Biostatistics and Health Informatics and King's Clinical Trials Unit, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - Hannah R. Scott
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Siobhan Hegarty
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Emilia Souliou
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Rupa Bhundia
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Danielle Lamb
- Department of Applied Health Research, University College London, UK
| | - Danny Weston
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Neil Greenberg
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas’ NHS Foundation Trust, UK
| | - Sharon Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics and King's Clinical Trials Unit, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| |
Collapse
|
36
|
Yang Toh SH, Lee SC, Kosasih FR, Lim JW, Sündermann O. Preliminary effectiveness of an evidence-based mobile application to promote resilience among working adults in Singapore and Hong Kong: Intensive longitudinal study. Digit Health 2023; 9:20552076231178616. [PMID: 37274370 PMCID: PMC10236254 DOI: 10.1177/20552076231178616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/11/2023] [Indexed: 06/06/2023] Open
Abstract
Evidence-based mobile health (mHealth) applications on smartphones are a cost-effective way for employees to take proactive steps to improve well-being and performance. However, little is known about what sustains engagement on these applications and whether they could dynamically improve occupational outcomes such as resilience and mood. Using real-world data, this intensive longitudinal study examines (a) which employees would continually engage with a cognitive behavioural therapy-informed mHealth application ('Intellect'); and (b) if daily engagement of 'Intellect' would relate to better occupational outcomes on the following day. A total of 515 working adults in Singapore and Hong Kong (Mage = 32.4, SDage = 8.17) completed daily in-app items on mood and resilience components (i.e. sleep hours, sleep quality, physical activity, and stress levels). Our results revealed that employees with lower baseline resilience (β = -0.048, odds ratio (OR) = 0.953, p < 0.01), specifically poorer sleep quality (β = -0.212, OR = 0.809, p = 0.001) and/or higher stress levels (β = -0.255, OR = 0.775, p = 0.05), were more likely to resume engagement on the application. Among the 150 active users (i.e. ≥3 consecutive days of engagement) (Mage = 32.2, SDage = 8.17), daily engagement predicted higher resilience (β = 0.122; 95% confidence interval (CI) 0.039-0.206), specifically lower stress levels (β = 0.018; 95% CI 0.004-0.032), higher physical activity (β = 0.079; 95% CI 0.032-0.126), and mood levels (β = 0.020; 95% CI 0.012-0.029) on the following day even after controlling for same-day outcomes. Our preliminary findings suggest that engaging with a mHealth application was associated with higher dynamic resilience and emotional well-being in employees.
Collapse
Affiliation(s)
| | - Sze Chi Lee
- Research Department, Intellect Pte Ltd,
Singapore
| | | | - Jia W. Lim
- Department of Psychology, National University of
Singapore, Singapore
| | - Oliver Sündermann
- Research Department, Intellect Pte Ltd,
Singapore
- Department of Psychology, National University of
Singapore, Singapore
| |
Collapse
|
37
|
Smit DJM, Proper KI, Engels JA, Campmans JMD, van Oostrom SH. Barriers and facilitators for participation in workplace health promotion programs: results from peer-to-peer interviews among employees. Int Arch Occup Environ Health 2023; 96:389-400. [PMID: 36305914 PMCID: PMC9614189 DOI: 10.1007/s00420-022-01930-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Workplace health promotion programs (WHPPs) have shown to be effective in improving lifestyle behaviors of employees. Despite potential benefits for employees, participation rates are generally low. The aim of this study was to gain deeper insight into barriers and facilitators for participation in WHPPs prior to implementation according to employees. METHODS Peer-to-peer interviewing, a method derived from citizen science, was used to actively involve employees in the data collection. Employees working in the cleaning-, ICT- and facility-sector were trained to interview their co-workers. Interviews were recorded and transcribed verbatim. Thematic analysis was performed using the Consolidated Framework for Implementation Research (CFIR), complemented with the constructs 'interpersonal factors' and 'intrapersonal factors' from the social ecological model. Data were coded deductively and inductively, and rated by two researchers independently. RESULTS Fourteen peer-interviewers conducted 62 peer-to-peer interviews. Main barriers for participation in WHPPs were an unsupportive organizational culture where lifestyle is not a common topic and programs that are not tailored to their needs. Support from peers and supervisors were facilitators. The availability of organizational resources, such as facilities and financial compensation, support participation. CONCLUSIONS To enhance participation of employees in WHPPs it is recommended to take into account the barriers and facilitators identified in this study. For instance, employees should be involved in the development and implementation of WHPPS by the employer and their needs and available resources should be taken into account. This may lead to more successful implementation and higher participation rates in future WHPPs.
Collapse
Affiliation(s)
- Denise J. M. Smit
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands ,Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karin I. Proper
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands ,Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Josephine A. Engels
- HAN University of Applied Sciences, Occupation and Health Research Group, Nijmegen, The Netherlands
| | - Jennifer M. D. Campmans
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Sandra H. van Oostrom
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| |
Collapse
|
38
|
Lee YJ. Effects of a mobile health intervention on activities of stress self-management for workers. Work 2023; 75:233-241. [PMID: 36591675 DOI: 10.3233/wor-211406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mobile health interventions are being widely tried because of their attractive advantages. However, there is not enough evidence for its effectiveness. OBJECTIVE This study aimed to evaluate the effects of mobile app-based stress management intervention (mSMI) on highly stressed workers. METHODS A sample of 82 white-collar workers with elevated symptoms of perceived stress (Perceived Stress Scale-10≥22) were randomly assigned to the intervention or control group. The mSMI consisted of three modules: self-management including a work diary, counseling based on cognitive behavioral therapy and interventions focused on music, meditation, relaxation and image healings. Self-report data were collected at the baseline and post-intervention. Study outcomes analyzed perceived stress, anxiety, depression, and work engagement. Data were assessed using analysis of covariance with covariates. RESULTS There was significantly reduced perceived stress from baseline to 6 weeks in mSMI (t = 5.788, p < 0.001) and control group (t = 3.184, p = 0.003). After adjusting for covariates, the between-group difference in the perceived stress was significantly different (F = 4.051, p = 0.048); however, the effect size was small. There was no significant intervention effect on anxiety, depression, and work engagement. The process evaluation indicated that most participants (85.3%) were satisfied with the intervention and their mental health benefited. CONCLUSION This study found that mobile health intervention facilitated perceived stress management for highly stressed workers. Further studies should address job-related outcomes and mental health symptoms in workers by applying the latest information technology and addressing the limitations of mobile interventions.
Collapse
Affiliation(s)
- Young Joo Lee
- Research Institute of Nursing Science, College of Nursing, Daegu Catholic University, Daegu, South Korea
| |
Collapse
|
39
|
Ponzo S, Wickham A, Bamford R, Radovic T, Zhaunova L, Peven K, Klepchukova A, Payne JL. Menstrual cycle-associated symptoms and workplace productivity in US employees: A cross-sectional survey of users of the Flo mobile phone app. Digit Health 2022; 8:20552076221145852. [PMID: 36544535 PMCID: PMC9761221 DOI: 10.1177/20552076221145852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Mood and physical symptoms related to the menstrual cycle affect women's productivity at work, often leading to absenteeism. However, employer-led initiatives to tackle these issues are lacking. Digital health interventions focused on women's health (such as the Flo app) could help fill this gap. Methods 1867 users of the Flo app participated in a survey exploring the impact of their menstrual cycle on their workplace productivity and the role of Flo in mitigating some of the identified issues. Results The majority reported a moderate to severe impact of their cycle on workplace productivity, with 45.2% reporting absenteeism (5.8 days on average in the previous 12 months). 48.4% reported not receiving any support from their manager and 94.6% said they were not provided with any specific benefit for issues related to their menstrual cycle, with 75.6% declaring wanting them. Users stated that the Flo app helped them with the management of menstrual cycle symptoms (68.7%), preparedness and bodily awareness (88.7%), openness with others (52.5%), and feeling supported (77.6%). Users who reported the most positive impact of the Flo app were 18-25% less likely to report an impact of their menstrual cycle on their productivity and 12-18% less likely to take days off work for issues related to their cycle. Conclusions Apps such as Flo could equip individuals with tools to better cope with issues related to their menstrual cycle and facilitate discussions around menstrual health in the workplace.
Collapse
Affiliation(s)
- Sonia Ponzo
- Flo Health
Inc., London, UK,Institute of Health Informatics, University College London, London,
UK,Sonia Ponzo, Flo Health Inc., 27 Old
Gloucester Street, London, WC1N 3AX, UK.
| | | | | | - Tara Radovic
- Flo Health
Inc., London, UK,Department of Psychology and Ergonomics,
Technische
Universitaet Berlin, Berlin, Germany
| | | | - Kimberly Peven
- Flo Health
Inc., London, UK,London School of Hygiene & Tropical Medicine, Maternal,
Adolescent, Reproductive & Child Health (MARCH) Centre, London, UK
| | | | - Jennifer L Payne
- Department of Psychiatry and Neurobehavioral Sciences,
University of
Virginia, Charlottesville, VA, USA
| |
Collapse
|
40
|
Ang WHD, Chew HSJ, Dong J, Yi H, Mahendren R, Lau Y. Digital training for building resilience: Systematic review, meta-analysis, and meta-regression. Stress Health 2022; 38:848-869. [PMID: 35460533 PMCID: PMC10084366 DOI: 10.1002/smi.3154] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/25/2022] [Accepted: 04/19/2022] [Indexed: 01/01/2023]
Abstract
Resilience is learnable and broadly described as an individual's adaptive coping ability, its potential value for stress reduction must be explored. With a global coronavirus pandemic, innovative ways to deliver resilience training amidst heightened mental health concerns must be urgently examined. This systematic review aimed to (1) evaluate the effectiveness of digital training for building resilience and reducing anxiety, depressive and stress symptoms and (2) to identify essential features for designing future digital training. A three-step search was conducted in eight electronic databases, trial registries and grey literature to locate eligible studies. Randomised controlled trials examining the effects of digital training aimed at enhancing resilience were included. Data analysis was conducted using the Stata version 17. Twenty-two randomised controlled trials involving 2876 participants were included. Meta-analysis revealed that digital training significantly enhanced the participants' resilience with moderate to large effect (g = 0.54-1.09) at post-intervention and follow-up. Subgroup analyses suggested that training delivered via the Internet with a flexible programme schedule was more effective than its counterparts. This review supports the use of digital training in improving resilience. Further high-quality randomised controlled trials with large sample size are needed.
Collapse
Affiliation(s)
- Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jie Dong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Rathi Mahendren
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
41
|
Bellon J, Quinlan C, Taylor B, Nemecek D, Borden E, Needs P. Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US. JAMA Netw Open 2022; 5:e2244644. [PMID: 36472875 PMCID: PMC9856223 DOI: 10.1001/jamanetworkopen.2022.44644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Outpatient behavioral health treatment (OPBHT) is an effective treatment for behavioral health conditions (BHCs) that may also be associated with improved medical health outcomes, but evidence regarding the cost-effectiveness of OPBHT across a large population has not been established. OBJECTIVE To investigate whether individuals newly diagnosed with a BHC who used OPBHT incurred lower medical and pharmacy costs over 15 and 27 months of follow-up compared with those not using OPBHT. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of commercially insured individuals in the US was conducted using administrative insurance claims data for individuals newly diagnosed with 1 or more BHCs between January 1, 2017, and December 31, 2018. Data were examined using a 12-month period before BHC diagnosis and 15- and 27-month follow-up periods. Participants included individuals aged 1 to 64 years who received any OPBHT with or without behavioral medication or who did not receive OPBHT or behavioral medication in the 15 months following diagnosis. Data were analyzed from May to October 2021. EXPOSURES Receipt of OPBHT both as a dichotomous variable and categorized by number of OPBHT visits. MAIN OUTCOMES AND MEASURES The main outcome was the association between OPBHT treatment and 15- and 27-month medical and pharmacy costs, assessed using a generalized linear regression model with γ distribution, controlling for potential confounders. RESULTS The study population included 203 401 individuals, of whom most were male (52%), White, non-Hispanic (75%), and 18 to 64 years of age (67%); 22% had at least 1 chronic medical condition in addition to a BHC. Having 1 or more OPBHT visits was associated with lower adjusted mean per-member, per-month medical and pharmacy costs across follow-up over 15 months (no OPBHT: $686 [95% CI, $619-$760]; ≥1 OPBHT: $571 [95% CI, $515-$632]; P < .001) and 27 months (no OPBHT: $464 [95% CI, $393-$549]; ≥1 OPBHT: $391 [95% CI, $331-$462]; P < .001). Furthermore, almost all doses of OPBHT across the 15 months following diagnosis were associated with lower costs compared with no OPBHT. CONCLUSIONS AND RELEVANCE In this cohort study, medical cost savings were associated with OPBHT among patients newly diagnosed with a BHC in a large, commercially insured population. The findings suggest that promoting and optimizing OPBHT may be associated with reduced overall medical spending among patients with BHCs.
Collapse
Affiliation(s)
| | | | | | | | - Eva Borden
- Evernorth Health, Inc, St Louis, Missouri
| | | |
Collapse
|
42
|
Shubina I. Scientific Publication Patterns of Systematic Reviews on Psychosocial Interventions Improving Well-being: Bibliometric Analysis. Interact J Med Res 2022; 11:e41456. [DOI: 10.2196/41456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/01/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Despite numerous empirical studies and systematic reviews conducted on the effectiveness of interventions improving psychological well-being, there is no holistic overview of published systematic reviews in this field.
Objective
This bibliometric study explored the scientific patterns of the effectiveness of different psychosocial interventions improving well-being among various categories of individuals with mental and physical diseases, to synthesize well-being intervention studies, and to suggest gaps and further studies in this emerging field.
Methods
The bibliometric analysis included identifying the most productive authors, institutions, and countries; most explored fields and subjects of study; most active journals and publishers; and performing citation analysis and analyzing publication trends between 2014 and 2022. We focused on data retrieved from known databases, and the study was conducted with a proven bibliometric approach.
Results
In total, 156 studies were found concerning the research domains and retrieved using LENS software from high-ranking databases (Crossref, Microsoft Academic, PubMed, and Core). These papers were written in English by 100 authors from 24 countries, among which, the leading country was the United Kingdom. Descriptive characteristics of the publications involved an increased number of publications in 2017 (n=35) and 2019 (n=34) and a decreased number in 2021 (n=4). The top 2 leading authors by citation score are James Thomas (3 papers and 260 citations) and Chris Dickens (3 papers and 182 citations). However, the most cited study had 592 citations. BMJ Open (n=6 articles) is the leading journal in the field of medicine; Clinical Psychology Review (n=5), in psychology; and Frontiers in Psychology, in psychological intervention (n=5) and psychology (n=5). The top 2 publishers were Wiley (n=28) and Elsevier (n=25).
Conclusions
This study indicates an overall interest in the declared domains within the last decade. Our findings primarily indicate that psychosocial interventions (PIs) were evaluated as being effective in managing mental and physical problems and enhancing well-being. Cognitive behavioral therapy was assessed as being effective in treating anxiety, psychoeducation in relapse prevention, and gratitude interventions in improving overall health, and the mindfulness approach had a positive impact on decreasing distress and depression. Moreover, all these intervention types resulted in an overall increase in an individuals’ well-being and resilience. Integrating social and cultural factors while considering individual differences increases the efficiency of PIs. Furthermore, PIs were evaluated as being effective in managing symptoms of eating disorders, dementia, and cancer. Our findings could help provide researchers an overview of the publication trends on research domains of focus for further studies, since it shows current findings and potential research needs in these fields, and would also benefit practitioners working on increasing their own and their patients' well-being.
Collapse
|
43
|
Olaya B, Van der Feltz-Cornelis CM, Hakkaart-van Roijen L, Merecz-Kot D, Sinokki M, Naumanen P, Shepherd J, van Krugten F, de Mul M, Staszewska K, Vorstenbosch E, de Miquel C, Lima RA, Ayuso-Mateos JL, Salvador-Carulla L, Borrega O, Sabariego C, Bernard RM, Vanroelen C, Gevaert J, Van Aerden K, Raggi A, Seghezzi F, Haro JM. Study protocol of EMPOWER: A cluster randomized trial of a multimodal eHealth intervention for promoting mental health in the workplace following a stepped wedge trial design. Digit Health 2022; 8:20552076221131145. [PMID: 36276189 PMCID: PMC9583218 DOI: 10.1177/20552076221131145] [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: 09/12/2021] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: This article describes the EMPOWER study, a controlled trial aiming to determine the effectiveness and cost-effectiveness of an eHealth intervention to prevent common health problems and reduce presenteeism and absenteeism in the workplace. Intervention: The EMPOWER intervention spans universal, secondary and tertiary prevention and consists of an eHealth platform delivered via a website and a smartphone app designed to guide employees throughout different modules according to their specific profiles. Design: A stepped-wedge cluster randomized trial will be implemented in four countries (Finland, Poland, Spain and UK) with employees from small and medium enterprises (SMEs) and public agencies. Companies will be randomly allocated in one of three groups with different times at which the intervention is implemented. The intervention will last 7 weeks. Employees will answer several questionnaires at baseline, pre- and post-intervention and follow-up. Outcome measures: The main outcome is presenteeism. Secondary outcomes include depression, anxiety, insomnia, stress levels, wellbeing and absenteeism. Analyses will be conducted at the individual level using the intention-to-treat approach and mixed models. Additional analyses will evaluate the intervention effects according to gender, country or type of company. Cost-effectiveness and cost-utility analyses [based on the use of quality-adjusted life-years (QALYS)] will consider a societal, employers' and employees' perspective.
Collapse
Affiliation(s)
- Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de
Déu, Sant Boi de Llobregat, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Madrid, Spain,Beatriz Olaya, Research, Innovation and
Teaching Unit, Parc Sanitari Sant Joan de Déu, Carrer Doctor Pujadas 42, 08830
Sant Boi de Llobregat, Spain.
| | - Christina M. Van der Feltz-Cornelis
- MHARG, Department of Health Sciences, Hull York Medical School, University of York, York, UK,Institute of Health Informatics, University College London, London,
UK
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy and Management (ESHPM), Erasmus
University Rotterdam, Rotterdam, The Netherlands
| | | | - Marjo Sinokki
- Turku Centre for Occupational Health, University of Turku, Turku, Finland
| | - Päivi Naumanen
- Turku Centre for Occupational Health, University of Turku, Turku, Finland
| | - Jessie Shepherd
- MHARG, Department of Health Sciences, Hull York Medical School, University of York, York, UK
| | - Frédérique van Krugten
- Erasmus School of Health Policy and Management (ESHPM), Erasmus
University Rotterdam, Rotterdam, The Netherlands
| | - Marleen de Mul
- Erasmus School of Health Policy and Management (ESHPM), Erasmus
University Rotterdam, Rotterdam, The Netherlands
| | | | - Ellen Vorstenbosch
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de
Déu, Sant Boi de Llobregat, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Madrid, Spain
| | - Carlota de Miquel
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de
Déu, Sant Boi de Llobregat, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Madrid, Spain
| | - Rodrigo Antunes Lima
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de
Déu, Sant Boi de Llobregat, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Madrid, Spain
| | - José Luis Ayuso-Mateos
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Madrid, Spain,Department of Psychiatry, Faculty of Medicine, Universidad Autónoma
de Madrid, Madrid, Spain
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia,National Centres for Epidemiology and Population Health, College of
Health and Medicine, Australian National University, Canberra, Australia
| | | | - Carla Sabariego
- Swiss Paraplegic Research
(SPF), Nottwil, Switzerland,Department of Health Sciences and Medicine, University of Lucerne,
Lucerne, Switzerland; Center for Rehabilitation in Global Health Systems, World
Health Organization Collaborating Center, University of Lucerne, Lucerne,
Switzerland
| | | | - Christophe Vanroelen
- Interface Demography, Department of Sociology, Vrije
Universiteit Brussel, Brussels, Belgium
| | - Jessie Gevaert
- Interface Demography, Department of Sociology, Vrije
Universiteit Brussel, Brussels, Belgium
| | - Karen Van Aerden
- Interface Demography, Department of Sociology, Vrije
Universiteit Brussel, Brussels, Belgium
| | - Alberto Raggi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, UO Neurologia
Salute Pubblica e Disabilità, Milano, Italy
| | | | | | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de
Déu, Sant Boi de Llobregat, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Madrid, Spain
| |
Collapse
|
44
|
Kurian RM, Thomas S. Importance of positive emotions in software developers’ performance: a narrative review. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2022. [DOI: 10.1080/1463922x.2022.2134483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Riba Maria Kurian
- Department of Psychology, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - Shinto Thomas
- Department of Psychology, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| |
Collapse
|
45
|
Sanders KH, Chousou PA, Carver K, Pugh PJ, Degens H, Azzawi M. Benefits of support groups for patients living with implantable cardioverter defibrillators: a mixed-methods systematic review and meta-analysis. Open Heart 2022; 9:openhrt-2022-002021. [PMID: 36252993 PMCID: PMC9577922 DOI: 10.1136/openhrt-2022-002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patients with implantable cardioverter defibrillators (ICD) experience anxiety, depression and reduced quality of life (QoL). OBJECTIVES This mixed-methods systematic review evaluates whether ICD support groups have a beneficial effect on mental well-being. METHODS Literature searches were carried out in MEDLINE, Embase, CINAHL, PsycINFO and Web of Science. Eligible studies investigated patient-led support groups for ICD patients aged 18 years or older, using any quantitative or qualitative design. The Mixed-Methods Assessment Tool was used to assess quality. Meta-analysis of measures of mental well-being was conducted. Thematic synthesis was used to generate analytic themes from the qualitative data. The data were integrated and presented using the Pillar Integration Process. RESULTS Ten studies were included in this review. All studies bar one were non-randomised or had a qualitative design and patients had self-selected to attend a support group. Five contributed to the quantitative data synthesis and seven to the qualitative synthesis. Meta-analysis of anxiety and QoL measures showed no significant impact of support groups on mental well-being, but qualitative data showed that patients perceived benefit from attendance through sharing experiences and acceptance of life with an ICD. DISCUSSION ICD support group attendance improved the patients' perceived well-being. Attendees value the opportunity to share their experiences which helps to accept their new life with an ICD. Future research could consider outcomes such as patient acceptance and the role of healthcare professionals at support groups.
Collapse
Affiliation(s)
- Katie H Sanders
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK,Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Panagiota Anna Chousou
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kathryn Carver
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter J Pugh
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hans Degens
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK,Lithuanian Sports University, Kaunas, Lithuania
| | - May Azzawi
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
46
|
Armaou M, Araviaki E, Dutta S, Konstantinidis S, Blake H. Effectiveness of Digital Interventions for Deficit-Oriented and Asset-Oriented Psychological Outcomes in the Workplace: A Systematic Review and Narrative Synthesis. Eur J Investig Health Psychol Educ 2022; 12:1471-1497. [PMID: 36286087 PMCID: PMC9601105 DOI: 10.3390/ejihpe12100102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Digital psychological interventions can target deficit-oriented and asset-oriented psychological outcomes in the workplace. This review examined: (a) the effectiveness of digital interventions for psychological well-being at work, (b) associations with workplace outcomes, and (c) associations between interventions' effectiveness and their theory-base. METHODS six electronic databases were searched for randomised controlled trials (RCT) and quasi-experimental studies. The methodological quality of studies that used randomisation was conducted with the "Cochrane Collaboration's Risk of Bias" tool, while the "JBI Critical Appraisal Checklist" was used for non-randomised studies. Studies' theory-base was evaluated using an adaptation of the "theory coding scheme" (TSC). Due to heterogeneity, narrative synthesis was performed. RESULTS 51 studies were included in a synthesis describing four clusters of digital interventions: (a) cognitive behavioural therapy, (b) stress-management interventions and workplace well-being promotion, (c) meditation training and mindfulness-based interventions, and (d) self-help interventions. Studies demonstrated a high risk of contamination effects and high attrition bias. Theory-informed interventions demonstrated greater effectiveness. Cognitive behavioural therapy demonstrated the most robust evidence for reducing depression symptoms among healthy employees. With the exception of the Headspace application, there was weak evidence for meditation training apps, while relaxation training was a key component of effective stress-management interventions.
Collapse
Affiliation(s)
- Maria Armaou
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
| | | | - Snigdha Dutta
- Cambridge Centre for Teaching and Learning, University of Cambridge, Cambridge CB2 3PT, UK
| | | | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
| |
Collapse
|
47
|
Moe-Byrne T, Shepherd J, Merecz-Kot D, Sinokki M, Naumanen P, Hakkaart-van Roijen L, Van Der Feltz-Cornelis C. Effectiveness of tailored digital health interventions for mental health at the workplace: A systematic review of randomised controlled trials. PLOS DIGITAL HEALTH 2022; 1:e0000123. [PMID: 36812547 PMCID: PMC9931277 DOI: 10.1371/journal.pdig.0000123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 09/09/2022] [Indexed: 06/08/2023]
Abstract
Mental health problems in the workplace are common and have a considerable impact on employee wellbeing and productivity. Mental ill-health costs employers between £33 billion and £42 billion a year. According to a 2020 HSE report, roughly 2,440 per 100,000 workers in the UK were affected by work-related stress, depression, or anxiety, resulting in an estimated 17.9 million working days lost. We performed a systematic review of randomised controlled trials (RCTs) to assess the effect of tailored digital health interventions provided in the workplace aiming to improve mental health, presenteeism and absenteeism of employees. We searched several databases for RCTs published from 2000 onwards. Data were extracted into a standardised data extraction form. The quality of the included studies was assessed using the Cochrane Risk of Bias tool. Due to the heterogeneity of outcome measures, narrative synthesis was used to summarise the findings. Seven RCTs (eight publications) were included that evaluated tailored digital interventions versus waiting list control or usual care to improve physical and mental health outcomes and work productivity. The results are promising to the advantage of tailored digital interventions regarding presenteeism, sleep, stress levels, and physical symptoms related to somatisation; but less for addressing depression, anxiety, and absenteeism. Even though tailored digital interventions did not reduce anxiety and depression in the general working population, they significantly reduced depression and anxiety in employees with higher levels of psychological distress. Tailored digital interventions seem more effective in employees with higher levels of distress, presenteeism or absenteeism than in the general working population. There was high heterogeneity in outcome measures, especially for work productivity; this should be a focus of attention in future studies.
Collapse
Affiliation(s)
| | - Jessie Shepherd
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Marjo Sinokki
- Turku Centre for Occupational Health, University of Turku, Turku, Finland
| | - Päivi Naumanen
- Turku Centre for Occupational Health, University of Turku, Turku, Finland
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Christina Van Der Feltz-Cornelis
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
| |
Collapse
|
48
|
Danieli M, Ciulli T, Mousavi SM, Silvestri G, Barbato S, Di Natale L, Riccardi G. Assessing the Impact of Conversational Artificial Intelligence in the Treatment of Stress and Anxiety in Aging Adults: Randomized Controlled Trial. JMIR Ment Health 2022; 9:e38067. [PMID: 36149730 PMCID: PMC9547337 DOI: 10.2196/38067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While mental health applications are increasingly becoming available for large populations of users, there is a lack of controlled trials on the impacts of such applications. Artificial intelligence (AI)-empowered agents have been evaluated when assisting adults with cognitive impairments; however, few applications are available for aging adults who are still actively working. These adults often have high stress levels related to changes in their work places, and related symptoms eventually affect their quality of life. OBJECTIVE We aimed to evaluate the contribution of TEO (Therapy Empowerment Opportunity), a mobile personal health care agent with conversational AI. TEO promotes mental health and well-being by engaging patients in conversations to recollect the details of events that increased their anxiety and by providing therapeutic exercises and suggestions. METHODS The study was based on a protocolized intervention for stress and anxiety management. Participants with stress symptoms and mild-to-moderate anxiety received an 8-week cognitive behavioral therapy (CBT) intervention delivered remotely. A group of participants also interacted with the agent TEO. The participants were active workers aged over 55 years. The experimental groups were as follows: group 1, traditional therapy; group 2, traditional therapy and mobile health (mHealth) agent; group 3, mHealth agent; and group 4, no treatment (assigned to a waiting list). Symptoms related to stress (anxiety, physical disease, and depression) were assessed prior to treatment (T1), at the end (T2), and 3 months after treatment (T3), using standardized psychological questionnaires. Moreover, the Patient Health Questionnaire-8 and General Anxiety Disorders-7 scales were administered before the intervention (T1), at mid-term (T2), at the end of the intervention (T3), and after 3 months (T4). At the end of the intervention, participants in groups 1, 2, and 3 filled in a satisfaction questionnaire. RESULTS Despite randomization, statistically significant differences between groups were present at T1. Group 4 showed lower levels of anxiety and depression compared with group 1, and lower levels of stress compared with group 2. Comparisons between groups at T2 and T3 did not show significant differences in outcomes. Analyses conducted within groups showed significant differences between times in group 2, with greater improvements in the levels of stress and scores related to overall well-being. A general worsening trend between T2 and T3 was detected in all groups, with a significant increase in stress levels in group 2. Group 2 reported higher levels of perceived usefulness and satisfaction. CONCLUSIONS No statistically significant differences could be observed between participants who used the mHealth app alone or within the traditional CBT setting. However, the results indicated significant differences within the groups that received treatment and a stable tendency toward improvement, which was limited to individual perceptions of stress-related symptoms. TRIAL REGISTRATION ClinicalTrials.gov NCT04809090; https://clinicaltrials.gov/ct2/show/NCT04809090.
Collapse
Affiliation(s)
- Morena Danieli
- Signal & Interactive Systems Lab, Dipartimento di Ingegneria e Scienze dell'Informazione, Università degli Studi di Trento, Povo di Trento - Trento, Italy
| | | | - Seyed Mahed Mousavi
- Signal & Interactive Systems Lab, Dipartimento di Ingegneria e Scienze dell'Informazione, Università degli Studi di Trento, Povo di Trento - Trento, Italy
| | | | | | | | - Giuseppe Riccardi
- Signal & Interactive Systems Lab, Dipartimento di Ingegneria e Scienze dell'Informazione, Università degli Studi di Trento, Povo di Trento - Trento, Italy
| |
Collapse
|
49
|
van der Scheer JW, Ansari A, McLaughlin M, Cox C, Liddell K, Burt J, George J, Kenny R, Cousens R, Leach B, McGowan J, Morley K, Willars J, Dixon-Woods M. Guiding organisational decision-making about COVID-19 asymptomatic testing in workplaces: mixed-method study to inform an ethical framework. BMC Public Health 2022; 22:1747. [PMID: 36109810 PMCID: PMC9476340 DOI: 10.1186/s12889-022-13993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Workplace programmes to test staff for asymptomatic COVID-19 infection have become common, but raise a number of ethical challenges. In this article, we report the findings of a consultation that informed the development of an ethical framework for organisational decision-making about such programmes. METHODS We conducted a mixed-method consultation - a survey and semi-structured interviews during November-December 2020 in a UK case study organisation that had introduced asymptomatic testing for all staff working on-site in its buildings. Analysis of closed-ended survey data was conducted descriptively. An analysis approach based on the Framework Method was used for the open-ended survey responses and interview data. The analyses were then integrated to facilitate systematic analysis across themes. Inferences were based on the integrated findings and combined with other inputs (literature review, ethical analysis, legal and public health guidance, expert discussions) to develop an ethical framework. RESULTS The consultation involved 61 staff members from the case study organisation (50 survey respondents and 11 interview participants). There was strong support for the asymptomatic testing programme: 90% of the survey respondents viewed it as helpful or very helpful. Open-ended survey responses and interviews gave insight into participants' concerns, including those relating to goal drift, risk of false negatives, and potential negative impacts for household members and people whose roles lacked contractual and financial stability. Integration of the consultation findings and the other inputs identified the importance of a whole-system approach with appropriate support for the key control measure of isolation following positive tests. The need to build trust in the testing programme, for example through effective communication from leaders, was also emphasised. CONCLUSIONS The consultation, together with other inputs, informed an ethical framework intended to support employers. The framework may support organisational decision-making in areas ranging from design and operation of the programme through to choices about participation. The framework is likely to benefit from further consultation and refinement in new settings.
Collapse
Affiliation(s)
- Jan W. van der Scheer
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Akbar Ansari
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Meredith McLaughlin
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
- Homerton College, Hills Rd, Cambridge, CB2 8PH UK
| | - Caitríona Cox
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Kathleen Liddell
- Faculty of Law, The David Williams Building, 10 West Rd, Cambridge, CB3 9DZ UK
| | - Jenni Burt
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Jenny George
- RAND Europe, Westbrook Centre/Milton Rd, Cambridge, CB4 1YG UK
| | - Rebecca Kenny
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Ruth Cousens
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Brandi Leach
- RAND Europe, Westbrook Centre/Milton Rd, Cambridge, CB4 1YG UK
| | - James McGowan
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | | | - Janet Willars
- Department of Health Sciences, University of Leicester, George Davies Centre, University Road, Leicester, LE1 7RH UK
| | - Mary Dixon-Woods
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| |
Collapse
|
50
|
Taylor H, Cavanagh K, Field AP, Strauss C. Health Care Workers’ Need for Headspace: Findings From a Multisite Definitive Randomized Controlled Trial of an Unguided Digital Mindfulness-Based Self-help App to Reduce Healthcare Worker Stress. JMIR Mhealth Uhealth 2022; 10:e31744. [PMID: 36006668 PMCID: PMC9459942 DOI: 10.2196/31744] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 02/27/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background Health care workers experience high stress. Accessible, affordable, and effective approaches to reducing stress are lacking. In-person mindfulness-based interventions can reduce health care worker stress but are not widely available or accessible to busy health care workers. Unguided, digital, mindfulness-based self-help (MBSH) interventions show promise and can be flexibly engaged with. However, their effectiveness in reducing health care worker stress has not yet been explored in a definitive trial. Objective This study aimed to investigate the effectiveness of an unguided digital MBSH app (Headspace) in reducing health care worker stress. Methods This was a definitive superiority randomized controlled trial with 2182 National Health Service staff in England recruited on the web and allocated in a 1:1 ratio to fully automated Headspace (n=1095, 50.18%) or active control (Moodzone; n=1087, 49.82%) for 4.5 months. Outcomes were subscales of the Depression, Anxiety, and Stress (primary outcome) Scale short form; Short Warwick Edinburgh Mental Well-being Scale; Maslach Burnout Inventory; 15-item Five-Facet Mindfulness Questionnaire minus Observe items; Self-Compassion Scale–Short Form; Compassionate Love Scale; Penn State Worry Questionnaire; Brooding subscale of the Ruminative Response Scale; and sickness absence. Results Intention-to-treat analyses found that Headspace led to greater reductions in stress over time than Moodzone (b=–0.31, 95% CI –0.47 to –0.14; P<.001), with small effects. Small effects of Headspace versus Moodzone were found for depression (b=–0.24, 95% CI –0.40 to –0.08; P=.003), anxiety (b=–0.19, 95% CI –0.32 to –0.06; P=.004), well-being (b=0.14, 95% CI 0.05-0.23; P=.002), mindfulness (b=0.22, 95% CI 0.09-0.34; P=.001), self-compassion (b=0.48, 95% CI 0.33-0.64; P<.001), compassion for others (b=0.02, 95% CI 0.00-0.04; P=.04), and worry (b=–0.30, 95% CI –0.51 to –0.09; P=.005) but not for burnout (b=–0.19, –0.04, and 0.13, all 95% CIs >0; P=.65, .67, and .35), ruminative brooding (b=–0.06, 95% CI –0.12 to 0.00; P=.06), or sickness absence (γ=0.09, 95% CI –0.18 to 0.34). Per-protocol effects of Headspace (454/1095, 41.46%) versus Moodzone (283/1087, 26.03%) over time were found for stress, self-compassion, and compassion for others but not for the other outcomes. Engagement (practice days per week) and improvements in self-compassion during the initial 1.5-month intervention period mediated pre- to postintervention improvements in stress. Improvements in mindfulness, rumination, and worry did not mediate pre- to postintervention improvements in stress. No serious adverse events were reported. Conclusions An unguided digital MBSH intervention (Headspace) can reduce health care workers’ stress. Effect sizes were small but could have population-level benefits. Unguided digital MBSH interventions can be part of the solution to reducing health care worker stress alongside potentially costlier but potentially more effective in-person mindfulness-based interventions, nonmindfulness courses, and organizational-level interventions. Trial Registration International Standard Randomised Controlled Trial Number ISRCTN15424185; https://tinyurl.com/rv9en5kc
Collapse
Affiliation(s)
- Heather Taylor
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Andy P Field
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Sussex Partnership NHS Foundation Trust, Hove, United Kingdom
| |
Collapse
|