The Effects of Workplace Nature-Based Interventions on the Mental Health and Well-Being of Employees: A Systematic Review

Designing LTC Physical Work Environments to Support Worker Well-being: A Review and Recommendations

OBJECTIVES

Well-designed, health-promoting physical work environments have the potential to reduce burnout and attrition for employees who work in long-term care (LTC) facilities. Unfortunately, there is limited existing guidance for LTC facility owners and operators related to specific health-promoting design strategies for LTC work environments. This narrative review aims to fill this knowledge gap.

METHODS

Information was synthesized from healthy-building certification standards for health care and non-health care buildings, LTC design guidelines, academic studies, and expert commentaries. The review was conducted in 3 phases to (1) identify specific space types and design characteristics generally considered to be health-supportive, (2) gather existing research on the identified strategies to critically analyze their supportive value, and (3) communicate the findings to a broad audience of stakeholders.

RESULTS

Five specific space types and 21 design characteristics were identified as both supportive of employee health and well-being, and relevant to LTC physical work environments.

CONCLUSIONS

When health care organizations construct new facilities or renovate existing facilities, using these health-promoting design strategies should be considered. Benefits of health-promoting physical work environments include better employee mental and physical health, less burnout, and less turnover. Reducing burnout and increasing employee retention is essential to mitigate the ongoing staffing crisis in the LTC industry.

Nature as a therapeutic place and tool for enhancing service users' engagement in mental health services: A comprehensive synthesis of evidence

This systematic review explored how nature-based care settings influence engagement in mental health therapy. We relied on Joanna Briggs Institute's guidelines for systematic reviews to synthesise data from nine articles selected from an initial pool of 649 records retrieved from PubMed, CINAHL, ScienceDirect, SocINDEX, and JBI EPB. Synthesis revealed six analytical themes: nature as a therapeutic tool, therapeutic relationships, nature's impact on power balance, nature as a safe space, risk of nature and patient-centered care. The findings shed light on the benefits while highlighting some challenges that influence participation in mental health interventions. The findings suggest that integrating nature into mental health care could be an alternative or complementary approach to enhancing patient engagement. However, the specific types of mental health care of this impact vary. Robust clinical trials that examine the effectiveness of the reported benefits are recommended. Such studies must target specific patient groups, such as the young and the elderly. Longitudinal studies that examine the long-term effects and moderating factors are needed to strengthen the evidence base and enhance patient-centered care.

Approaches for the Use of AI in Workplace Health Promotion and Prevention: Systematic Scoping Review

BACKGROUND

Artificial intelligence (AI) is an umbrella term for various algorithms and rapidly emerging technologies with huge potential for workplace health promotion and prevention (WHPP). WHPP interventions aim to improve people's health and well-being through behavioral and organizational measures or by minimizing the burden of workplace-related diseases and associated risk factors. While AI has been the focus of research in other health-related fields, such as public health or biomedicine, the transition of AI into WHPP research has yet to be systematically investigated.

OBJECTIVE

The systematic scoping review aims to comprehensively assess an overview of the current use of AI in WHPP. The results will be then used to point to future research directions. The following research questions were derived: (1) What are the study characteristics of studies on AI algorithms and technologies in the context of WHPP? (2) What specific WHPP fields (prevention, behavioral, and organizational approaches) were addressed by the AI algorithms and technologies? (3) What kind of interventions lead to which outcomes?

METHODS

A systematic scoping literature review (PRISMA-ScR [Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews]) was conducted in the 3 academic databases PubMed, Institute of Electrical and Electronics Engineers, and Association for Computing Machinery in July 2023, searching for papers published between January 2000 and December 2023. Studies needed to be (1) peer-reviewed, (2) written in English, and (3) focused on any AI-based algorithm or technology that (4) were conducted in the context of WHPP or (5) an associated field. Information on study design, AI algorithms and technologies, WHPP fields, and the patient or population, intervention, comparison, and outcomes framework were extracted blindly with Rayyan and summarized.

RESULTS

A total of 10 studies were included. Risk prevention and modeling were the most identified WHPP fields (n=6), followed by behavioral health promotion (n=4) and organizational health promotion (n=1). Further, 4 studies focused on mental health. Most AI algorithms were machine learning-based, and 3 studies used combined deep learning algorithms. AI algorithms and technologies were primarily implemented in smartphone apps (eg, in the form of a chatbot) or used the smartphone as a data source (eg, Global Positioning System). Behavioral approaches ranged from 8 to 12 weeks and were compared to control groups. Additionally, 3 studies evaluated the robustness and accuracy of an AI model or framework.

CONCLUSIONS

Although AI has caught increasing attention in health-related research, the review reveals that AI in WHPP is marginally investigated. Our results indicate that AI is promising for individualization and risk prediction in WHPP, but current research does not cover the scope of WHPP. Beyond that, future research will profit from an extended range of research in all fields of WHPP, longitudinal data, and reporting guidelines.

TRIAL REGISTRATION

OSF Registries osf.io/bfswp; https://osf.io/bfswp.

Students' perceived restorativeness of university environment: the validation of the Rest@U scale

University students are likely to encounter mental health issues throughout their educational journey. Among the various factors that can impact students' wellbeing, the physical environment can potentially restore cognitive, physiological, and emotional resources, thereby enhancing academic performance, and overall quality of life, while reducing feelings of stress and depression. The Perceived Restorativeness Scale is the most commonly used tool to assess the level of restorativeness derived from the educational physical environment. However, a tailored measure could be a more psychometrically suitable approach to capture the context-specific characteristics of university environments for academic students. This study aimed to validate an instrument that can accurately evaluate university spaces to measure the perceived restorativeness of university students. A total sample of 685 students from two Italian universities participated in the evaluation of the psychometric properties of the Restorativeness at University scale (Rest@US), consisting of 13 items divided into four dimensions: fascination, being-away, scope, and coherence. The hypothesised four-factor model (being-away, fascination, scope, and coherence) demonstrated excellent fit indices in both the calibration and validation samples and was invariant for sex. The scale demonstrates good reliability. Furthermore, criterion validity has been confirmed, highlighting that, in a theoretically consistent manner, the perceived restorativeness of university physical environments from the point of view of students and its dimensions were negatively correlated with techno-overload and study-related workload and positively correlated with perceived performance and psycho-physical wellbeing.

Fine-tuning the practical relevance of a quality framework for integrated nature-based interventions in healthcare facilities. A qualitative interview study

Introduction

Integrated nature-based interventions in healthcare facilities are gaining importance as promising health and biodiversity promotion strategies. This type of interventions combines the restoration of biodiversity in the vicinity of the healthcare facility with guiding patients in that natural environment for health outcomes. However, quality appraisal of these interventions is still poorly developed. Based on a recent scoping review, the authors developed a preliminary quality framework in support of healthcare facilities designing, implementing and evaluating integrated nature-based interventions. This present study aims to fine-tune the practical relevance of the quality framework within the emerging practice.

Methods

A qualitative interview study was conducted in seven healthcare facilities in Belgium. Using a combination of snowball and purposive sampling, 22 professionals, involved in the integrated nature-based intervention in their facility, participated in the study. The semi-structured interviews were transcribed and imported into NVivo. A deductive and inductive thematic analysis was used to explore the practical relevance of the quality framework. A stakeholders' assembly review and a member checking of the findings were also part of the study.

Findings

Twenty-two interviews with nature management coordinators, healthcare professionals, and healthcare managers were conducted by three principal investigators in seven healthcare facilities implementing integrated nature-based interventions. The contextualization and complexity of integrated nature-based interventions in the participating healthcare facilities demonstrated the need for an evidence-based quality framework describing nature-based interventions. The study led to nine quality criteria, confirming the eight quality criteria derived from a previous scoping review, and the identification of a new quality criterion 'Capacity building, leverage and continuity'. These quality criteria have been refined. Finally, a proposal for a quality framework was developed and operationalized in a checklist. Deployment of the quality framework should be embedded in a continuous cyclical, adaptive process of monitoring and adjusting based on evaluations at each phase of an integrated nature-based intervention.

Discussion

Bridging the domains of healthcare and nature management in the context of an integrated nature-based intervention in a healthcare facility requires a transdisciplinary approach. Scientific frameworks such as "complex interventions," Planetary Health and One Health can support the co-design, implementation and evaluation of integrated nature-based interventions within a cyclical, adaptive process. In addition, the importance of the quality of the interactions with nature could gain from more sophisticated attention. Finally, the implications for healthcare facilities, policymakers and education are discussed, as well as the strengths and limitations of the study.

Impacts of noise-induced hearing loss on sleep, health, and workplace: Multi-group analysis

Noise-induced hearing loss (NIHL) is a significant occupational health concern, particularly in industries with high levels of noise exposure. This study examines the effects of NIHL on sleep quality, daily life health conditions, and workplace health problems among workers. A total of 1285 workers participated in the study, and the data were analyzed using partial least squares structural equation modeling (PLS-SEM) to assess the impacts of NIHL. The analysis included a multi-group analysis to differentiate the effects between workers who wear noise protection and those who do not. Our findings indicate that NIHL significantly affects sleep quality, with a coefficient of 0.263 (t = 9.957, p<0.001), daily life health conditions with a coefficient of 0.296 (t = 10.793, p<0.001), and workplace health problems with a coefficient of 0.345 (t = 13.814, p<0.001). The multi-group analysis revealed more severe impacts on sleep and health in the non-wearing group compared to the noise-protection-wearing group, with statistically significant differences in path coefficients for sleep disorders (-0.033), health problems in daily life (-0.184), and health problems in the workplace (-0.190), all showing p-values of 0.000. These results underscore the detrimental effects of NIHL on multiple aspects of workers' health and emphasize the importance of wearing noise protection to mitigate these effects. This study provides vital insights for both researchers and practitioners in public health, suggesting that improved noise protection strategies are essential for protecting workers in noisy environments.

Quality criteria of nature-based interventions in healthcare facilities: a scoping review

Introduction

Implementing integrated nature-based interventions that simultaneously serve human health and the restoration of biodiversity in healthcare facilities is considered a promising strategy. As an emerging field of research and practice in healthcare, identification of quality criteria is necessary to support desired outcomes related to biodiversity, human health and intervention processes. This study is part of a larger research project in collaboration with the Flemish Agency of Nature and Forest in Belgium.

Methods

A scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews, in PubMed, Medline, Web of Science and Scopus. A step-by-step tabular screening process was conducted to identify relevant studies and reviews of nature-based interventions, published in English between January 2005 and April 2023. A qualitative content analysis was conducted and the results were then presented to the project steering group and a panel of stakeholders for refinement.

Results

After filtering on the eligibility criteria, and with focus on healthcare facilities, 14 articles were included in this study. A preliminary nature-based interventions quality framework with a set of quality indicators has been developed.

Discussion

When designing integrated nature-based interventions, a needs analysis of users and the outdoor environment should be conducted. Next, the integration of a One Health and biodiversity perspective and the application of a complex intervention framework, could support the quality of the design and implementation of nature-based interventions in healthcare facilities and facilitate their assessment. In future work, more rigorous research into the design and implementation of integrated nature-based interventions is needed to test and refine the quality criteria in practice.

The outdoor office: a pilot study of environmental qualities, experiences of office workers, and work-related well-being

Outdoor office work is an emerging aspect of the concept of 'new ways of working', but only sparse data are available about the environmental qualities of the outdoor office space, experiences of office workers, and work-related well-being of outdoor office work. Here, we present an exploratory pilot study on well-being and outdoor office work in a public urban space. An outdoor office was set up in the courtyard of a university campus, and the participants (n = 16) conducted office work outdoors for 30 min and thereafter participated in an eye-tracking session for 11-15 min (n = 8) and subsequently filled out surveys (n = 16). The eye tracker allowed the discovery of natural and built elements in the outdoor environment that caught the participants' visual attention, whereas the surveys assessed aspects of their subjective experiences of the outdoor office space (its visual and spatial qualities) and the work there. The results are presented as network graphs where correlations are shown regarding different aspects of office work outdoors. The results indicate that outdoor office work in a public urban space may promote work-related well-being in terms of positive outdoor office space experiences. Based on the findings, a preliminary set of outdoor office qualities is proposed. Those qualities relate to the legibility and imageability of the outdoor office space, its focal points, and depth/spaciousness, in addition to attributes of usability and environmental richness, including if the outdoor office space affords natural contact and supports activities, in addition to social and individual interactions and relations.

Nature-Based Interventions for Autistic Children: A Systematic Review and Meta-Analysis

Importance

There is a gap in the evidence regarding nature-based interventions (NBIs) for children with autism spectrum disorder (ASD).

Objective

To systematically review and meta-analyze available evidence on the health-related outcomes in NBIs for children with ASD.

Data Sources

The Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase, Emcare, Education Resources Information Center, Global Health, MEDLINE, PsycInfo, SPORTDiscus, and Web of Science were searched from inception until May 2023. Google Scholar and references from included studies were searched for additional studies.

Study Selection

Included studies were randomized clinical trials (RCTs), controlled studies, and single-group before-and-after studies that reported health-related outcomes.

Data Extraction and Synthesis

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guidelines. Random-effects meta-analyses were used to synthesize the data. The findings of studies that were ineligible for meta-analysis were summarized according to the Synthesis Without Meta-analysis (SWIM) reporting guidelines.

Main Outcomes and Measures

The outcomes of interest were health-related outcomes (ie, social functioning, behavioral functioning, emotional functioning, sensory functioning) and the self-reported well-being of children with ASD.

Results

A total of 24 studies with 717 participants (mean age range, 5.3 to 17.8 years; 141 [21.9%] female) were included. A meta-analysis from 13 studies indicated a significant negative moderate association between NBIs and social communication (standardized mean difference [SMD], -0.59; 95% CI, -0.85 to -0.34). For behavioral functioning outcomes, NBIs showed a significant moderate association with reduced hyperactivity (SMD, -0.56; 95% CI, -0.86 to -0.26) and a small to moderate association with reduced irritability (SMD, -0.49; 95% CI, -0.79 to -0.19). For sensory functioning, NBIs were significantly associated with improved inattention and distractibility (SMD, 1.13; 95% CI, 0.67 to 1.60). Significant moderate associations were observed in sensory seeking (SMD, 0.77; 95% CI, 0.33 to 1.22; P < .001; I2 = 0%) and sensory sensitivity (SMD, 0.56; 95% CI, 0.12 to 1.00; P = .01; I2 = 0%). Heterogeneity of the intervention effects was not high, and I2 ranged from 0% to 67%.

Conclusions and Relevance

The findings of this systematic review and meta-analysis suggested an association of NBIs in group-based recreational therapy with experiential learning with positive short-term outcomes on sensory, social, and behavioral functioning for children with ASD. Future evidence using robust study design to aid the health and functional trajectories of children with ASD is recommended.

Interdisciplinary approach to defining outdoor places of knowledge work: quantified photo analysis

Introduction

Working outdoors is an emerging, sparsely studied phenomenon in knowledge work. Office tasks have traditionally been considered to belong to indoor environments. The worldwide pandemic of COVID-19 has increased and changed attitudes toward multilocational working. The aim of this method study is 2-fold: first to define for interdisciplinary context outdoor environments when they are used as places of outdoor knowledge work and second to quantify the thematic photo analysis to support interdisciplinary understanding of the places of outdoor knowledge work.

Methods

The review of literature has been one of the methods to support the interdisciplinary approach of this article. The photographs of outdoor knowledge workplaces and views from the workstations are studied through photo analysis customized from the existing press photograph analysis.

Results

First, we defined outdoor environments when used as places of outdoor knowledge work, as unconditioned outdoor or semi-outdoor places (opposite to closed indoor spaces with stable, conditioned indoor climate) providing favorable action possibilities as sources of comfort and mitigating unfavorable conditions, for example, by microclimatic solutions. Instead of defining all spaces as outdoor environments not fulfilling a stable indoor climate (conditioned) definition, adaptation to thermal and physical environments also brought semi-outdoor space into the definition. In this context, favorable latent action possibilities (affordance) in the built environment are often related to microclimate as a source of comfort. Second, we focussed on photo analysis. The proposed model is based on journalistic photo analysis PPSA and the pOKW model, which have been further developed in this study to pOKW2 model for analyzing mobile-based collected self-reported photographs by the occupants. In this pOKW2 model, the photographs would have time-location information enabling the combining of data from other datasets and thereby reducing the number of characteristics to be analyzed from the photograph. We proposed rating (in numeric form) to detect the favorable and unfavorable characteristics in the photographs most likely supporting or hindering conditions of outdoor knowledge work. This quantification would enable the use of machine vision analysis and would support handling large quantities of photographs and their combination with other datasets in interdisciplinary research.

Discussion

The quantification of the photo analysis (pOKW2) includes the readiness to combine the analysis results with other time-location-specific datasets in an interdisciplinary research collaboration to advance our understanding of latent action possibilities for outdoor knowledge work.

Nature-Based Interventions and Exposure among Cancer Survivors: A Scoping Review

BACKGROUND AND PURPOSE

nature-based interventions (NBI) have been shown to have positive effects on physical, psychological, social, and spiritual health. The purpose of this scoping literature review was to describe what is known regarding the cancer survivor experience in relationship to their interaction with the natural environment. Description/methods: this review was completed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The research strategy included a combination of these terms: cancer, neoplasms, nature, and forest therapy. The articles were blinded and screened by four independent researchers. A total of twelve articles were selected. Outcome/results: a total of 2786 cancer survivors participated in the twelve studies with multiple types and stages of cancer represented. The studies used multiple designs and measures. Results showed improvements in anxiety, depression, sleep, connectedness, stress, tension, confusion, fatigue, and pain. Participants reported that nature was the most important resource in coping with their cancer.

CONCLUSIONS AND IMPLICATIONS

nature is beneficial for cancer survivors while they experience cancer diagnosis and treatment. Nature opportunities can be feasibly delivered with this population and need to be explored further and safely implemented to support the overall health and well-being of cancer survivors.

Flow experience and city identity in the restorative environment: A conceptual model and nature-based intervention

Within environmental psychology, the restorative environment is receiving increasing attention due to its favorable impact on people's mental recovery, stress reduction, and psychophysiological well-being. Flow theory, as one of the foundations of positive psychology, is a popular theoretical framework for understanding human flourishing and well-being. The restorative environment is suggested to facilitate flow experience and city identity from the perspective of positive environmental psychology. Nonetheless, systematic research investigating them all together can hardly be traced. Thus, through a preliminary review of 169 relevant studies retrieved from the data source, this work proposes a novel theoretical model in which people's interactions within the restorative environment facilitate their experience of flow and perceived city identity. Additionally, this research provides conceptual guidance for city workers to engage in nature-based intervention and leisure therapy for improved well-being. Overall, this review endeavors to contribute to developing urban workers' restoration, happiness, and well-being from both practical and theoretical perspectives.

Expanding the Mind-Body-Environment Connection to Enhance the Development of Cultural Humility

The unique health care needs of diverse individuals and communities are complex. To meet these needs, healthcare professionals are being called upon to alter traditional ways of thinking, perceiving, and acting in order to create more inclusive environments. Research shows that using mindsight, a process that increases both insight and empathy, can enhance an individual's mind-body-environment connection, increase self-awareness, and promote the development of cultural humility. This paper will discuss the current perspectives on the mind/body/environment connection from a Western lens that may impact the enactment of cultural humility for healthcare providers. Two evidence-based approaches, yoga and forest therapy, are recommended as effective intervention tools in fostering mindsight and cultural humility. Blending traditional cognitive learning with techniques anchored in the physical body may hold promise in supporting the development of mindsight and cultural humility in healthcare education and practice.

Theoretically derived interventions aimed at improving appropriate polypharmacy in primary care: A systematic review

Background

Polypharmacy (the use of multiple medications) is common in older patients and achieving a balance between appropriate and inappropriate polypharmacy is a challenge routinely faced by prescribers. It is recommended to incorporate the use of theory when developing complex interventions, but it is not known if theoretically derived interventions aimed at improving appropriate polypharmacy are effective.

Objective

This systematic review aimed to establish the overall effectiveness of theoretically derived interventions on improving appropriate polypharmacy and to investigate the degree to which theory informed intervention design.

Methods

Seven electronic databases were searched from inception to August 2021 including hand-searching of reference lists. Interventions developed using a theory, involving the use of a validated tool to assess prescribing, delivered in primary care to participants with a mean age of ≥65 years and prescribed ≥four medications, were included. Data was extracted independently by two reviewers. The Theory Coding Scheme (TCS) was applied to evaluate the use of theory; Risk of Bias (RoB) was assessed using the Cochrane RoB 2.0 tool.

Results

Two studies, one feasibility study and one randomised controlled trial (RCT) were included, and therefore overall effectiveness of the theoretically derived intervention could not be assessed. Theory used in development included the Theoretical Domains Framework and Reason's system-based risk management theory. The RCT was rated to have a high RoB. Based on the TCS, neither study used theory completely.

Conclusion

The effectiveness of theoretically derived interventions to improve appropriate polypharmacy in primary care could not be determined due to the small number of studies and their heterogeneity. Further incorporation of theory into intervention development is required to understand the effectiveness of this approach.Prospero registration: CRD42020157175.

Lifestyle Prescription for Depression with a Focus on Nature Exposure and Screen Time: A Narrative Review

Recent lifestyles changes have favored increased time in contact with screens and a parallel reduction in contact with natural environments. There is growing awareness that nature exposure and screen time are related to depression. So far, the roles of how these environmental lifestyles affect depressive symptoms and disorders have not been reviewed simultaneously. The aim of this review was to gather the literature regarding the role of nature exposure and screen time in depression. An emphasis was made on clinical samples of patients with well-defined depression and the different methodological approaches used in the field. A second goal was to suggest an agenda for clinical practice and research. Studies were included if they assessed depressive symptoms in patients with a clinical diagnosis of depression. An overview of the published literature was conducted using three scientific databases up to December 2021. Several interventions involving nature exposure have shown positive effects on depressive symptoms and mood-related measures. The most consistent finding suggests that walks in natural environments may decrease depressive symptoms in patients with clinical depression. Less researched interventions, such as psychotherapy delivered in a forest or access to natural environments via virtual reality, may also be effective. In contrast, fewer observational studies and no experimental research on screen time have been conducted in patients with clinical depression. Thus, recommendations for practice and research are also discussed. Scarce research, diverse interventions, and several methodological shortcomings prevent us from drawing conclusions in this area. More high-quality experimental research is needed to establish interventions with proven efficacy in clinical depression. At this stage, it is too early to formulate practice guidelines and advise the prescription of these lifestyles to individuals with depression. The present findings may serve as a basis to develop strategies based on nature exposure and screen time targeting clinical depression.

Workplace-based occupational therapy for mental health in Africa: a scoping review protocol

INTRODUCTION

Although mental health at work is a pressing and growing concern, mental healthcare accounts for less than 2% of global healthcare, with marked inequality across continents. Africa has the smallest proportion of mental health service providers, and the highest rate of out-of-pocket expenditure for mental health service users. Poor mental health at work results in costs to workers, employers and the economy. This review aims to collaborate with stakeholders to identify literature on workplace-based occupational therapy interventions supporting the mental health of workers in Africa.

METHODS AND ANALYSIS

We will search Medline (PubMed), EBSCOhost (Academic Search Premier, AfricaWide Information, CINAHL, Health Source: Nursing/Academic), Scopus, Web of Science, Sabinet, Cochrane and OTSeeker for qualitative and quantitative primary research studies. Grey literature will be searched via Sabinet and ProQuest. No language or date restrictions will be applied. Title and abstract screening as well as full-text screening will be done independently by two reviewers. Data extracted will include information about the articles, characteristics of studies and interventions, and findings. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines will be used for reporting results. Three groups of stakeholders will be consulted during the review process: service users/workers, employers and service providers/occupational therapists.

ETHICS AND DISSEMINATION

This scoping review does not require ethics approval. Findings of the review will be disseminated through stakeholder engagements, peer-reviewed publications and conference presentations.

Testing a New Protocol of Nature-Based Intervention to Enhance Well-Being: A Randomized Control Trial

This study aims to test the associations of nature contact with multiple dimensions of psychological functioning. A total of 90 university employees were randomly assigned to spend their lunch breaks on (1) a 30-min structured protocol of nature contact and (2) a control group for 10 consecutive weekdays. Psychological distress, psychological well-being, and work-related psychological outcomes were assessed at baseline (T1), the day after the 10-day intervention (T2), and three months after the intervention (T3). Mixed-design analyses of variance (ANOVA) were conducted. Overall, significant intervention effects were found in the structured protocol of nature contact on psychological distress, well-being outcomes, and work engagement (all p < 0.05), whereas the 3-month post-intervention effects were non-significant. Our study showed that nature-based activities during lunch breaks could enhance office workers’ mental health in general, but the effects could be short-lived, calling for regular nature-based programs in occupational settings.

Effects of Nature-Based Intervention in Occupational Health Care on Stress – A Finnish Pilot Study Comparing Stress Evaluation Methods

Purpose

To assess methodology and its limitations for measuring effects of nature-based intervention (NBI).

Patients and Methods

Participants were 11 middle-aged female health care workers with lowered capacity to work. NBI included six group appointments in six months study period. Heart rate variability (HRV) and self-reported pain and work exhaustion were measured pre-post study period. Salivary α-amylase samples were collected immediately before and after three individual interventions. Salivary cortisol samples were collected on the same three interventions, on three consecutive days starting from the day of intervention, to assess (a) month effect (pre-post study period) and (b) day effect (intervention day vs non-intervention day).

Results

Individual interventions resulted in increase in α-amylase activity. However, the average fold increase decreased from the 3.05 ± 1.20 of the first intervention to 1.91 ± 1.00 and 1.46 ± 0.77 in the second and third intervention, respectively (p < 0.001). Cortisol concentrations were lower on intervention days vs non-intervention days, the difference being indicative (p = 0.050). Pain and work exhaustion decreased during the study period, as well as HRV, although any of these changes was not statistically significant.

Conclusion

For a large-scale study, it would be ideal to select assays for both major pathways: hypothalamic-pituitary-adrenal axis can be measured by cortisol, whereas response via autonomic nervous system can be measured by HRV, when roles of sympathetic and parasympathetic nervous systems can be pinpointed separately. Salivary α-amylase can be used when continuous monitoring is not possible. Psychological well-being of participants should be surveyed, as well as their activities and moods on sampling days recorded.

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

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.

Virtual reality as a tool to promote wellbeing in the workplace

Background

NHS staff are disproportionately impacted by workplace stress, threatening not only quality of service delivery, but the sustainability, of this vital healthcare system. There is an urgent need for accessible and cost-effective interventions that promote the wellbeing of this integral workforce.

Aim

The aim of this study was to explore the potential propensity of a short virtual reality (VR) nature experience, delivered during the workday, to induce positive mood states NHS clinicians.

Method

NHS clinicians working in a fast-paced trauma service were offered the opportunity to take part in a short virtual reality (VR) relaxation session, during their working day, in which they were able to explore the “Green Meadows” experience available within the Nature Treks application. An indication of physiological arousal (heart rate) was obtained, and subjective measures of emotional state were employed to assess the effect of the intervention on participants’ mood. Further, feedback was gathered to provide an initial indication of the acceptability of the experience.

Results

Analysis of data from 39 clinicians revealed that, following the VR experience, participants reported significantly increased feelings of happiness (p < 0.001) and relaxation (p < 0.001), and significantly decreased feelings of sadness (p = 0.003), anger (p < 0.001) and anxiety (p < 0.001). No significant differences in reported levels of surprise (p = 0.603) or vigour (p = 0.566) were found. Further, the experience was associated with a significant reduction in heart-rate (p = 0.025), and had high acceptability ratings, despite participants’ varied experience with computers and VR technology.

Conclusions

The findings of this study indicate that the administration of VR for the promotion of NHS staff wellbeing in the workplace is a potentially fruitful avenue of exploration that warrants further investigation.

Introducing nature at the work floor: A nature-based intervention to reduce stress and improve cognitive performance

BACKGROUND

Although a growing body of research has shown that exposure to nature has restorative effects on human health, the potential beneficial effects of nature-based interventions in the working environment are still underexplored.

METHODS

We performed a randomized controlled study with a nature-based program during working hours. We enrolled employees, randomized the participants into two groups being an intervention and a control group. Twice a week for three consecutive weeks, the intervention group participated in nature-based activities for 2 h. The primary outcomes were cognitive performance, burnout assessment, salivary cortisol levels, and continuous stress levels. We performed intervention-response analyses using mixed-effects models that included random effects for each participant across the different examinations.

RESULTS

Compared to the control group (n = 20), the intervention group (n = 25) participating in the nature-based program had a lower Burnout Assessment Tool score (-14.9% CI-16.2 to -14.3, difference; p < 0.001), lower salivary cortisol levels (-29.3% CI-34.7 to -25.3; p < 0.001) and higher visual information processing speed (7.4% CI6.9-8.0; p < 0.001). Selective attention of the participants that participated in the nature-based program improved during the interventions (-10.6 CI-19.6 to -6.9, p = 0.045), compared to the controls.

CONCLUSIONS

This study provides novel evidence that exposure to nature during work hours reduces stress and improves cognitive performance. The trial is registered with ClinicalTrials.gov, number: NCT04111796.

Healthy lifestyle interventions across diverse workplaces: a summary of the current evidence

PURPOSE OF REVIEW

Workplaces provide a unique opportunity to deliver health promotion interventions to their workers. This review summarizes evidence from the most recent studies (September 2019 to April 2021) of workplace healthy lifestyle interventions and identifies gaps in the literature and key aspects for successful future workplace lifestyle interventions.

RECENT FINDINGS

Recent intervention studies have focused on four health domains: (1) multicomponent wellness programs, (2) healthy diet interventions, (3) physical activity interventions, and (4) mental health/sleep interventions. Within each group of studies, there was significant heterogeneity in study length, intervention components, and worker populations. Nonetheless, most studies across all categories showed positive associations between healthy lifestyle interventions and improved worker health.

SUMMARY

Although recent literature has shown an overall positive trend between healthy lifestyle interventions implemented at the workplace and improvements in markers of health and wellbeing, further research should include longer follow-up periods, more objective measures of wellbeing, evaluation of worker performance, and analogous interventions between studies to identify the most effective interventions to improve worker health and wellness.

Operationalization of One Health Burnout Prevention and Recovery: Participatory Action Research-Design of Nature-Based Health Promotion Interventions for Employees

Burnout is, besides a global, complex phenomenon, a public health issue with negative consequences on personal, organizational, social, and economic levels. This paper outlines the co-design of a novel Nature-based Burnout Coaching intervention, called NABUCO. Due to the complexity of burnout, we propose a One Health approach in healthcare, educational and governmental pilot organizations, to deliver guidelines and protocols for prevention and recovery of burnout. We advocate the inclusion of the salutogenic and mutual healing capacity of nature connectedness, facilitating a positive impact on mental and environmental health. A transdisciplinary Participative Action Research-design resulted in an iterative adaptive cycle of co-design, implementation, and evaluation of NABUCO.

Cross-Cultural Comparison of Mental Health Between German and South African Employees: Shame, Self-Compassion, Work Engagement, and Work Motivation

The negative impact of the coronavirus disease outbreak 2019 (COVID-19) on work mental health is reported in many countries including Germany and South Africa: two culturally distinct countries. This study aims to compare mental health between the two workforces to appraise how cultural characteristics may impact their mental health status. A cross-sectional study was used with self-report measures regarding (i) mental health problems, (ii) mental health shame, (iii) self-compassion, (iv) work engagement and (v) work motivation. 257 German employees and 225 South African employees have completed those scales. This study reports results following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. T-tests, correlation and regression analyses were performed. German employees had lower mental health problems and mental health shame, and higher self-compassion than South Africans. Mental health problems were positively associated with mental health shame and amotivation, and negatively associated with work engagement and intrinsic motivation in both groups. Lastly, self-compassion, a PP 2.0 construct, was the strongest predictor for mental health problems in both countries. Our results suggest (i) that German culture's long-term orientation, uncertainty avoidance and restraint may help explain these differences, and (ii) that self-compassion was important to mental health in both countries. While the levels of mental health differed between the two countries, cultivating self-compassion may be an effective way to protect mental health of employees in those countries. Findings can help inform managers and HR staff to refine their wellbeing strategies to reduce the negative impact of the pandemic, especially in German-South African organizations.

Paramedic experiences of providing care in wales (UK) during the 2020 COVID-19 pandemic (PECC-19): a qualitative study using evolved grounded theory

OBJECTIVE

To explore paramedic experiences of providing care during the 2020 COVID-19 pandemic and develop theory in order to inform future policy and practice.

DESIGN

Qualitative study using constructivist evolved grounded theory (EGT) methodology. One-to-one semistructured interviews were conducted using a general interview guide. Voice over Internet Protocol was used through Skype.

SETTING

Conducted between March 2020 and November 2020 in the Welsh Ambulance Services National Health Services Trust UK which serves a population of three million.

PARTICIPANTS

Paramedics were recruited through a poster circulated by email and social media. Following purposive sampling, 20 Paramedics were enrolled and interviewed.

RESULTS

Emergent categories included: Protect me to protect you, Rapid disruption and adaptation, Trust in communication and information and United in hardship. The Basic Social Process was recognised to involve Tragic Choices, conceptualised through an EGT including Tragic personal and professional choices including concerns over personnel protective equipment (PPE), protecting themselves and their families, impact on mental health and difficult clinical decisions, Tragic organisational choices including decision making support, communication, mental health and well-being and Tragic societal choices involving public shows of support, utilisation and resourcing of health services.

CONCLUSIONS

Rich insights were revealed into paramedic care during the COVID-19 pandemic consistent with other research. This care was provided in the context of competing and conflicting decisions and resources, where Tragic Choices have to be made which may challenge life's pricelessness. Well-being support, clinical decision making, appropriate PPE and healthcare resourcing are all influenced by choices made before and during the pandemic, and will continue as we recover and plan for future pandemics. The impact of COVID-19 may persist, especially if we fail to learn, if not we risk losing more lives in this and future pandemics and threatening the overwhelming collective effort which united society in hardship when responding to the COVID-19 Pandemic.

TRIAL REGISTRATION NUMBER

IRAS ID: 282 623.

The Interrelationship of Shinrin-Yoku and Spirituality: A Scoping Review

Background and objectives: Shinrin-yoku (SY; Forest Bathing) is an integrative practice known to improve humans' physiologic and psychologic health and well-being by mindfully using the five human senses while relaxing in natural environments. In addition, it may be effective in enhancing or revealing human spirituality. The World Health Organization defines an individual's well-being as an awareness of one's fullest possible physical, psychologic, social, spiritual, and economic self. Recent evidence suggests that nature promotes spiritual well-being. Hence, the authors performed a scoping review of the literature with regard to the evidence of the interrelationship of SY/nature and spirituality with an aim to identify gaps in knowledge and assist with furthering empirical research. Methods: The PRISMA extension for Scoping Reviews (PRISMA-ScR) methodological approach, presented by Tricco et al., was utilized by searching the electronic databases, CINAHL, Google Scholar, Scopus, PubMed, PsychInfo, and ScienceDirect separately, for authors using key terms shinrin-yoku, forest bathing, nature based therapy, spirituality, health, wellbeing, awe, and wonder. Results: Of the 30 publications, 13 met the eligibility criteria and were included in the synthesis. The authors discovered that, despite the different research methodologies and publications, nature may have a positive effect on human spirituality and, therefore, enriching individuals' well-being. Conclusions: SY is an integrative practice that may enhance or actualize human spirituality. More research is needed to determine the interrelationship of SY and human spirituality in achieving one's fullest possible self.

Association Between Work and Common Mental Disorders in School Adolescents: The ERICA Study

OBJECTIVES

Adolescence is characterized by continuing profound mental, physical, and social changes and entering into the labor market during this phase may have negative consequences on physical and mental health. Common mental disorders (CMD) are characterized as disorders of mental functions, including symptoms of depression and anxiety as well as various nonspecific and somatic complaints such as reduced ability to concentrate, tiredness, irritation, and forgetfulness. Despite its increasing prevalence, few studies have addressed CMD and its association with work, in adolescents. In the present study, we aimed to identify the main factors associated with CMD and evaluated its association with work, in school adolescents.

METHODS

A cross-sectional study was conducted with 12 to 17-year-old adolescent students using a self-administered questionnaire with questions related to work. CMD was verified using the General Health Questionnaire of 12 items. In total, 3424 adolescents were studied.

RESULTS

The prevalence of CMD and work in the last year was 28.72% and 19.63%, respectively. After adjustment for potential confounding variables, multivariate analysis showed associations of CMD with female gender (OR=2.72) and work (OR=1.70).

CONCLUSION

In the present study, a high number of cases of CMD were observed among the studied adolescents. Female gender and work history in the last year were negatively and independently associated with the presence of CMD.