Process Evaluation in Occupational Stress Management Programs: A Systematic Review

'Safety in the Grey Zone': Evaluation of a training program to improve the safety of incident responders on high-speed roads

INTRODUCTION

Workers operating on high-speed roads (i.e., incident responders and emergency service workers) are at significant risk of being fatally injured while working. An identified gap in current prevention strategies is training focused on developing the skills of workers to effectively communicate and coordinate safety responses when operating on roads.

METHODS

This study discusses the development of a program designed to optimize communication and coordination of safety practices at the scene of an incident on a high-speed road. The program is referred to as 'Safety in the Grey Zone.' The goal of the study is to present the results from an evaluation on its implementation across 23 sessions involving 158 participants from 7 incident response agencies in 1 state in Australia.

RESULTS

The results of this study provide support for effectiveness in implementing the program as planned. The results also provide preliminary support for effectiveness of the program in achieving its learning outcomes as demonstrated by feedback received from participants following completion of the program.

CONCLUSIONS

The findings of this study provide recommendations to consider in the program's future roll-out, as well as suggestions for future evaluations to assess the program's effectiveness in improving the safety of incident responders operating on high-speed roads.

Experiences in the application of logic models in the context of workplace health promotion - A focus group discussion

Gathering evidence on complex workplace health promotion interventions faces methodological challenges. Therefore, the application of logic models as a theory of change is recommended to support outcome and process evaluations. The present study explores challenges and opportunities of applying logic models in application-oriented intervention research on workplace health promotion. A focus group (n = 6), consisting of scientists and workplace health promotion practitioners, was conducted using a semi-structured interview guide. The recorded qualitative data were transcribed and analysed using the structuring content analysis method. According to the focus group, logic models provide several opportunities for planning and evaluating complex workplace health promotion interventions. Logic models support the communication between science and practice, and have benefits for the provider of workplace health promotion interventions. The main challenges in working with logic models were dealing with the complex and constantly developing intervention and with the derivation and implementation of reasonable evaluation methods. The focus group exposed repeated application and a shared understanding between stakeholders as facilitators for working with logic models. In conclusion, at the science-practice interface, logic models could enhance the integrative understanding and the further development of evidence-based workplace health promotion.

Assessing the efficacy of a job rotation for improving occupational physical and psychosocial work environment, musculoskeletal health, social equality, production quality and resilience at a commercial laundromat: protocol for a longitudinal case study

INTRODUCTION

Job rotation is a work organisation strategy used to reduce work-related exposures and musculoskeletal complaints, yet evidence for the efficacy of the approach is weak. Mismatch between job rotation and company needs, lack of full implementation, lack of exposure variation in included tasks and failure to assess variation may underlie inconclusive research findings to date. The study aims to develop a job rotation with company stakeholders, perform a process evaluation of the implementation, and determine the extent to which the intervention improves the physical and psychosocial work environment, indicators of health, gender and social equality among workers and production quality and resilience.

METHODS AND ANALYSIS

Approximately 60 production workers at a Swedish commercial laundromat will be recruited. Physical and psychosocial work environment conditions, health, productivity and gender and social equality will be assessed pre and post intervention, using surveys, accelerometers, heart rate, electromyography and focus groups. A task-based exposure matrix will be constructed, and exposure variation estimated at the level of the individual worker pre and post intervention. An implementation process evaluation will be conducted. Job rotation efficacy will be assessed in terms of improvement in work environment conditions, health, gender and social inequality, and production quality and resilience. This study will provide novel information on the effects of the job rotation on physical and psychosocial work environment conditions, production quality and rate, health and gender and social inequality among blue-collar workers in a highly multicultural workplace.

ETHICS AND DISSEMINATION

The study received approval from the Swedish Ethical Review Authority (reference number 2019-00228). The results of the project will be shared directly with the employees, managers and union representatives from the participating company, other relevant labour market stakeholders and with researchers at national and international conferences and via scientific publication.

TRIAL REGISTRATION NUMBER

The study is preregistered with the Open Science Framework (https://osf.io/zmdc8/).

Managers' Action-Guiding Mental Models towards Mental Health-Related Organizational Interventions-A Systematic Review of Qualitative Studies

Research indicates that managers' active support is essential for the successful implementation of mental health-related organizational interventions. However, there is currently little insight into what subjective beliefs and perceptions (=mental models) make leaders support such interventions. To our knowledge, this is the first qualitative systematic review of this specific topic, and it considers 17 qualitative studies of managers' perspective. Based on the theory of planned behavior, this review provides an overview of three action-guiding factors (attitudes, organizational norms and behavioral control) that can serve as starting points for engaging managers in the implementation of mental health-related measures and ensuring their success. Our results provide evidence that supportive organizational norms may particularly help to create a common sense of responsibility among managers and foster their perceived controllability with respect to changing working conditions. Our study thus contributes to a more differentiated understanding of managers' mental models of health-related organizational interventions.

Co-Creating an Occupational Health Intervention within the Construction Industry in Sweden: Stakeholder Perceptions of the Process and Output

One way to prevent work-related stress, is to implement primary occupational health interventions aimed at improving the psychosocial work environment. However, such interventions have shown a limited effect, often due to implementation failure and poor contextual fit. Co-creation, where researchers, together with end-users and other relevant stakeholders, develop the intervention is increasingly encouraged. However, few studies have evaluated the effects of co-created interventions, and participants’ experience of the co-creation process. This is one of the first studies evaluating stakeholder perceptions of co-creating an occupational health intervention. We applied a thematic analysis, with data from 12 semi-structured interviews with stakeholders involved in the co-creation. Our results show that the respondents, in general, were satisfied with engaging in the co-creation, and they reported an increased awareness regarding risk factors of stress and how these should be handled. Additionally, the respondents described trust in the intervention activities and a good fit into the context. The study indicates that co-creating occupational health interventions can enhance the implementation and the contextual fit.

Assessing the Role of Collective Efficacy Beliefs During Participative Occupational Health Interventions

Background: For group-based participatory interventions in the context of occupational health, no questionnaires exist to assess the participants' active engagement in the interventions. On the basis of the construct of collective efficacy beliefs, this study has developed a questionnaire with which the group-related efficacy beliefs can be assessed as a precondition for participants actively engaging in participative interventions. Methods: Participants were drawn from a two-arm cluster-randomized intervention study to fill out the questionnaire. A Factor analysis and an initial psychometric calibration were performed. In a second step, the group-related properties of the questionnaire were validated using a Multilevel analysis. Results: The factorial structure of the questionnaire is consistent with the theory of efficacy beliefs according to A. Bandura. Furthermore, the collective efficacy expectations of the interventions' participants are lowered in the absence of appreciation and support in the psychosocial environment of the worksite. Conclusions: Assessing participant's quality of interventional activity in participatory interventions by collective efficacy can be valuable in understanding the amount of interventional activity. In addition, it is recommended to consider the influence of the worksite's psychosocial environment on collective efficacy beliefs when implementing participatory interventions. Clinical Trial Registration: Registration trial DRKS00021138 on the German Registry of Clinical Studies (DRKS), retrospectively registered on 25 March, 2020.

Relocation to Activity-Based Workplaces (ABW)-Importance of the Implementation Process

Activity-based workplaces (ABW) have been implemented in many organizations to offer office flexibility and decrease facility costs. Evaluations of the ABW implementation process are rare. The study aimed to examine the ABW relocation process of two offices in a Swedish governmental agency and to explore factors that influence the implementation process and satisfaction with it. Qualitative or quantitative data were collected on process variables (context, recruitment, reach, dose delivered, dose received, satisfaction), barriers and facilitators to the process were explored in focus group interviews, and immediate outcomes (perceived knowledge, understanding office rules, satisfying information and support) were measured by questionnaire before and after the relocation. The evaluation showed that recruitment was unsatisfactory and reach insufficient—and participation in activities was thus low for both offices. However, intended changes improved. Unclear aims of ABW, lack of manager support and, lack of communication were some of the reported barriers to participation, while a well-planned process, work groups, and program activities were facilitators. Thus, to increase satisfaction with the relocation, our results suggest that recruitment should be thoroughly planned, taking these factors into account to increase participation. This knowledge may be useful for planning and designing successful ABW relocations and evaluations.

Implementation of an organizational intervention to improve low-wage food service workers' safety, health and wellbeing: findings from the Workplace Organizational Health Study

Background

Many organizational interventions aim to improve working conditions to promote and protect worker safety, health, and well-being. The Workplace Organizational Health Study used process evaluation to examine factors influencing implementation of an organizational intervention. This paper examines the extent to which the intervention was implemented as planned, the dose of intervention implemented, and ways the organizational context hindered or facilitated the implementation of the intervention.

Methods

This proof-of-concept trial was conducted with a large, multinational company that provides food service through contractual arrangements with corporate clients. The 13-month intervention was launched in five intervention sites in October 2018. We report findings on intervention implementation based on process tracking and qualitative data. Qualitative data from 25 post-intervention interviews and 89 process tracking documents were coded and thematically analyzed.

Results

Over the 13-month intervention, research team representatives met with site managers monthly to provide consultation and technical assistance on safety and ergonomics, work intensity, and job enrichment. Approximately two-thirds of the planned in-person or phone contacts occurred. We tailored the intervention to each site as we learned more about context, work demands, and relationships. The research team additionally met regularly with senior leadership and district managers, who provided corporate resources and guidance. By assessing the context of the food service setting in which the intervention was situated, we explored factors hindering and facilitating the implementation of the intervention. The financial pressures, competing priorities and the fast-paced work environment placed constraints on site managers’ availability and limited the full implementation of the intervention.

Conclusions

Despite strong support from corporate senior leadership, we encountered barriers in the implementation of the planned intervention at the worksite and district levels. These included financial demands that drove work intensity; turnover of site and district managers disrupting continuity in the implementation of the intervention; and staffing constraints that further increased the work load and pace. Findings underscore the need for ongoing commitment and support from both the parent employer and the host client.

Trial registration

This study was retrospectively registered with the Clinical Trials. Gov Protocol and Results System on June 2, 2021 with assigned registration number NCT04913168.

Implementation of participatory organizational change in long term care to improve safety

INTRODUCTION

Long Term Care (LTC) facilities are fast-paced, demanding environments placing workers at significant risk for injuries. Health and safety interventions to address hazards in LTC are challenging to implement. The study assessed a participatory organizational change intervention implementation and impacts.

METHODS

This was a mixed methods implementation study with a concurrent control, conducted from 2017 to 2019 in four non-profit LTC facilities in Ontario, Canada. Study participants were managers and frontline staff. Intervention sites implemented a participatory organizational change program, control sites distributed one-page health and safety pamphlets. Program impact data were collected via Survey (self-efficacy, control over work, pain and general health) and observation (Quick Exposure Checklist). Interviews/focus groups were used to collect program implementation data.

RESULTS

Participants described program impacts (hazard controls through equipment purchase/modification, practice changes, and education/training) and positive changes in culture, communication and collaboration. There was a statistically significant difference in manager self-efficacy for musculoskeletal disorder (MSD) hazards between the control and intervention sites over time but no other statistical differences were found. Key program implementation challenges included LTC hazards, staff shortage/turnover, safety culture, staff time to participate, and communication. Facilitators included frontline staff involvement during implementation, management support, focusing on a single unit, training, and involving an external program facilitator.

CONCLUSION

A participatory program can have positive impacts on identifying and reducing MSD hazards. Key to success is involving frontline staff in identifying hazards and creating solutions and management encouragement on a unit working together. High turnover rates, staffing shortages, and time constraints were barriers as they are for all organizational change efforts in LTC. The implementation findings are likely applicable in any jurisdiction. Practical Application: Implementing a participatory organizational change program to reduce MSD hazards is feasible in LTC and can improve communication and aid in identification and control of hazards.

Implementing practices focused on workplace health and psychological wellbeing: A systematic review

RATIONALE

Workplace health and wellbeing practices (WHWPs) often fail to improve psychological health or wellbeing because of implementation failure. Thus, implementation should be evaluated to improve the effectiveness of WHWPs.

OBJECTIVE

We conducted a systematic review to identify critical success factors for WHWP implementation and gaps in the evidence. Doing so provides a platform for future theoretical development.

METHODS

We reviewed 74 separate studies that assessed the implementation of WHWPs and their effects on psychological health or psychological wellbeing. Most studies were from advanced industrial Western democracies (71). Intervention types included primary (e.g., work redesign, 37 studies; and health behavior change, 8 studies), secondary (e.g., mindfulness training, 11 studies), tertiary (e.g., focused on rehabilitation, 9 studies), and multifocal (e.g., including components of primary and secondary, 9 studies).

RESULTS

Tangible changes preceded improvements in health and wellbeing, indicating intervention success cannot be attributed to non-specific factors. Some interventions had beneficial effects through mechanisms not planned as part of the intervention. Three factors were associated with successful WHWP implementation: continuation, learning, and effective governance.

CONCLUSIONS

The review indicates future research could focus on how organizations manage conflict between WHWP implementation and existing organizational processes, and the dynamic nature of organizational contexts that affect and are affected by WHWP implementation. This systematic review is registered [PROSPERO: the International Prospective Register of Systematic Reviews ID: CRD42019119656].

Effects of relocation to activity-based workplaces on perceived productivity: Importance of change-oriented leadership

Activity-based workplaces (ABWs) are becoming popular in Western countries and were implemented at four office sites of a large Swedish government agency. A fifth office was used as a control group. The study aim was to examine the effects of relocation to ABW on perceived productivity among employees and to determine if perceived change-oriented leadership behavior prior to relocation moderates potential effects. Data were collected three months prior to relocation, and three and 12 months after. 407 respondents were included in linear mixed regression models. Perceived productivity decreased significantly after relocation compared to the control group and these effects persisted 12 months after the relocation. However, the decrease in perceived productivity was significantly smaller among employees perceiving high change-oriented leadership before relocation. Our results point out the importance of a change-oriented leadership behavior during the implementation to avoid productivity loss among employees when implementing ABWs.

Teachers' psychological well-being role of emotional intelligence and resilient character traits in determining the psychological well-being of Indian school teachers

Purpose

The substance of the present study lies in analysing the extent to which intrinsic factors like emotional intelligence and resilient character traits impact the psychological well-being of school teachers. It prominences the mediating role of resilient character traits in the relationship between emotional intelligence and psychological well-being of teachers.

Design/methodology/approach

This cross-sectional survey study recruits a sample of 200 school teachers across the state of Haryana, India, with the help of a convenience sampling technique.

Findings

The findings from parallel multiple mediation indicate perseverance as a significant mediator and predictor of psychological well-being among factors of resilient traits, and self-reliance emerges as an inconsistent, yet significant mediator in the relationship between emotional intelligence and well-being of teachers. The direct effect of emotional intelligence on psychological well-being also emerged as statistically significant. Additionally, the female school teachers show higher emotional intelligence and resilience as compared to the male school teachers.

Practical implications

The research is not an unmitigated work in the exploration of a causal relationship between the study variables. However, the study draws practical suggestions for improving the perseverant and emotionally intelligent behaviour of teachers for better emotional and psychological adjustment at work. It acknowledges the role of school administration and education policymakers in furthering the betterment of teachers' psychological state for improved performance and effectiveness. Also, teamwork, stress reduction and leadership building appeared to be helpful contributors to enhance the perseverance and emotional intelligence among teachers.

Originality/value

Studies in the field of school administration rarely address the psychological well-being of school teachers as their concern. This study accentuates the impact of intrinsic antecedents of psychological well-being, which is neither well conceptualised in Indian studies nor is causally related to any psychological constructs. Therefore, it remarkably contributes to the literature in the field of educational management and leadership, providing an insight into the psyche of teachers from “the Orient”.

Process evaluation within pragmatic randomised controlled trials: what is it, why is it done, and can we find it?-a systematic review

BACKGROUND

Process evaluations are increasingly conducted within pragmatic randomised controlled trials (RCTs) of health services interventions and provide vital information to enhance understanding of RCT findings. However, issues pertaining to process evaluation in this specific context have been little discussed. We aimed to describe the frequency, characteristics, labelling, value, practical conduct issues, and accessibility of published process evaluations within pragmatic RCTs in health services research.

METHODS

We used a 2-phase systematic search process to (1) identify an index sample of journal articles reporting primary outcome results of pragmatic RCTs published in 2015 and then (2) identify all associated publications. We used an operational definition of process evaluation based on the Medical Research Council's process evaluation framework to identify both process evaluations reported separately and process data reported in the trial results papers. We extracted and analysed quantitative and qualitative data to answer review objectives.

RESULTS

From an index sample of 31 pragmatic RCTs, we identified 17 separate process evaluation studies. These had varied characteristics and only three were labelled 'process evaluation'. Each of the 31 trial results papers also reported process data, with a median of five different process evaluation components per trial. Reported barriers and facilitators related to real-world collection of process data, recruitment of participants to process evaluations, and health services research regulations. We synthesised a wide range of reported benefits of process evaluations to interventions, trials, and wider knowledge. Visibility was often poor, with 13/17 process evaluations not mentioned in the trial results paper and 12/16 process evaluation journal articles not appearing in the trial registry.

CONCLUSIONS

In our sample of reviewed pragmatic RCTs, the meaning of the label 'process evaluation' appears uncertain, and the scope and significance of the term warrant further research and clarification. Although there were many ways in which the process evaluations added value, they often had poor visibility. Our findings suggest approaches that could enhance the planning and utility of process evaluations in the context of pragmatic RCTs.

TRIAL REGISTRATION

Not applicable for PROSPERO registration.

Career Crafting Training Intervention for Physicians: Protocol for a Randomized Controlled Trial

BACKGROUND

Physicians work in a highly demanding work setting where ongoing changes affect their work and challenge their employability (ie, their ability and willingness to continue working). In this high-pressure environment, physicians could benefit from proactively managing or crafting their careers; however, they tend not to show this behavior. The new concept of career crafting concerns proactively making choices and adapting behavior regarding both short-term job design (ie, job crafting) as well as longer-term career development (ie, career self-management). However, so far, no intervention studies have aimed at enhancing career crafting behavior among physicians. Given that proactive work and career behavior have been shown to be related to favorable outcomes, we designed an intervention to support career crafting behavior and employability of physicians.

OBJECTIVE

The objectives of this study were to describe (1) the development and (2) the design of the evaluation of a randomized controlled career crafting intervention to increase job crafting, career self-management, and employability.

METHODS

A randomized controlled intervention study was designed for 141 physicians in two Dutch hospitals. The study was designed and will be evaluated based on parts of the intervention mapping protocol. First, needs of physicians were assessed through 40 interviews held with physicians and managers. This pointed to a need to support physicians in becoming more proactive regarding their careers as well as in building awareness of proactive behaviors in order to craft their current work situation. Based on this, a training program was developed in line with their needs. A number of theoretical methods and practical applications were selected as the building blocks of the training. Next, participants were randomly assigned to either the waitlist-control group (ie, received no training) or the intervention group. The intervention group participated in a 4-hour training session and worked on four self-set goals. Then, a coaching conversation took place over the phone. Digital questionnaires distributed before and 8 weeks after the intervention assessed changes in job crafting, career self-management, employability, and changes in the following additional variables: job satisfaction, career satisfaction, work-home interference, work ability, and performance. In addition, a process evaluation was conducted to examine factors that may have promoted or hindered the effectiveness of the intervention.

RESULTS

Data collection was completed in March 2020. Evaluation of outcomes and the research process started in April 2020. Study results were submitted for publication in September 2020.

CONCLUSIONS

This study protocol gives insight into the systematic development and design of a career crafting training intervention that is aimed to enhance job crafting, career self-management, and employability. This study will provide valuable information to physicians, managers, policy makers, and other researchers that aim to enhance career crafting.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/18432.

Delivering cognitive analytic consultancy to community mental health teams: Initial practice-based evidence from a multi-site evaluation

OBJECTIVES

This study sought to employ the hourglass model to frame the methodological evolution of outcome studies concerning 5-session cognitive analytic consultancy (CAC).

DESIGN

Pre-post mixed methods evaluation (study one) and mixed methods case series (study two).

METHODS

In study one, three sites generated acceptability and pre-post effectiveness outcomes from N = 58 care dyads, supplemented with qualitative interviewing. The client outcome measures included the Clinical Outcomes in Routine Evaluation Outcome Measure, Personality Structure Questionnaire, Work and Social Adjustment Questionnaire, Service Engagement Scale, and the Working Alliance Inventory. Study two was a mixed methods case series (N = 5) using an A/B phase design with a 6-week follow-up. Client outcome measures were the Personality Structure Questionnaire, Clinical Outcomes in Routine Evaluation Outcome Measure, and the Working Alliance Inventory, and the staff outcome measures were the Working Alliance Inventory, Maslach Burnout Inventory, and the Perceived Competence Scale.

RESULTS

In study one, the cross-site dropout rate from CAC was 28.40% (the completion rate varied from 58 to 100%) and full CAC attendance rates ranged from 61 to 100%. Significant reductions in client distress were observed at two sites. Qualitative themes highlighted increased awareness and understanding across care dyads. In study two, there was zero dropout and full attendance. Clients were significantly less fragmented, and staff felt significantly more competent and less exhausted. Potential mechanisms of change were the effective process skills of the consultant and that emotionally difficult CAC processes were helpful.

CONCLUSIONS

Cognitive analytic consultancy appears a promising approach to staff consultation, and testing in a clinical trial is now indicated.

PRACTITIONER POINTS

CAC is a suitable method of consultation for care dyads struggling to work effectively together in CMHTs. Staff feel more competent and clients feel less fragmented following CAC, and the benefits of CAC appear to be maintained over follow-up time. CAC processes can be difficult for care coordinator and client, but this is not an impediment to change.

Development of a Generic Workshop Appraisal Scale (WASC) for Organizational Health Interventions and Evaluation

This study presents the development of a generic workshop appraisal scale (WASC) for the evaluation of organizational health interventions. Based on the session evaluation questionnaire (SEQ) by Stiles (1980), we developed a short, generic 10-item scale with pairs of adjectives, covering five facets: comprehensibility, relevance, novelty, activation, and valence. Our study is based on N = 499 employees from four organizations who participated in 41 workshops and filled out an evaluation questionnaire on-site. The questionnaire contained the newly developed WASC, as well as items capturing satisfaction with the developed output and outcome expectancies. Results from confirmative factor analysis confirmed the hypothesized five-factor structure of the WASC. The factor structure was found to be nearly invariant across the four organizations, a result that needs to be replicated in larger samples. Analysis of intra-class correlations indicated that 25% of the variance in workshop appraisal can be explained at workshop level. Hereby, perceived relevance and novelty exhibited lower amounts of shared variance, indicating that corresponding workshop appraisals are influenced more by individual factors and less by group dynamics. Furthermore, results from mediation analysis revealed that participants’ workshop appraisals were significantly related to their outcome expectancies, and that this relationship was mediated by output satisfaction. Again, the facets showed differential effects: Relevance and comprehensibility seem to contribute most to the total effect on outcome expectancy, followed by activation, whereas valence and especially novelty play a minor role. Taken together, participants’ workshop appraisals – together with output satisfaction and outcome expectancy – may be helpful for monitoring the implementation process and allow for corrective action if necessary.

Relationship between intervention dosage and success of resource connections in a social needs intervention

OBJECTIVES

Social needs interventions in medical settings aim to mitigate the effects of adverse social circumstances on health outcomes by connecting vulnerable patients with resources. This study examined the relationship between intervention dosage and the success of resource connections using data from a social needs intervention in multiple clinical settings across the US.

STUDY DESIGN

The intervention uses a case management approach to connect patients with unmet needs to resources and services in the community. Intervention dosage was conceptualized as the number of contacts between the navigator and the patient, categorized as direct contact (phone vs. in person) and indirect contact (initiated by the navigator vs. patient). Success of the intervention was conceptualized as 'none,' 'partial,' or 'optimal' for each patient, based on the number of social needs the resource connections addressed.

METHODS

Administrative data were extracted for 38,404 unique patients who screened positive for unmet resource needs between 2012 and 2017. Owing to the large sample size, statistical corrections were made to reduce type I error.

RESULTS

Multinomial logistic regression analyses showed that higher intervention dosage was related to greater success of resource connections, after adjusting for the patient and site characteristics, and the number of needs (odds ratios ranged from 1.62 to 2.89). In-person contact, although received by only 25% of the patients, was associated with the highest probability of optimal success.

CONCLUSIONS

This study demonstrates a feasible way to conceptualize an intervention dose for a social needs intervention that uses a case management approach and has implications for how intervention delivery may improve success of resource connections.

Decreasing employees' work stress by a participatory, organizational level work stress prevention approach: a multiple-case study in primary education

Background

Work stress is an important problem among employees in education in the Netherlands. The present study aims to investigate the effects of a participatory organizational level work stress prevention approach to reduce (quantitative) job demands, increase resources (i.e. autonomy, supervisor and coworker support) and to reduce work stress and increase job satisfaction of employees in primary education.

Methods

This study makes use of a multiple case study research design. The stress prevention approach is implemented at 5 primary schools and questionnaires were filled out by 119 employees of the 5 schools at baseline and 1 year later, measuring job demands, resources, work stress, job satisfaction and implementation factors.

Results

Multilevel analyses showed a significant decrease in job demands and a significant increase in job satisfaction between baseline and follow up. In addition, employees that were more satisfied with the communication about the intervention showed more improvements in autonomy and job satisfaction. However, employees reporting an increased dialogue in work stress between employees and management showed a smaller decrease in job demands.

Conclusion

The study shows a decrease in job demands and an increase in job satisfaction in the schools that implemented a stress prevention approach. Results of the study underline the importance of communication about the intervention as part of the implementation process, impacting the effectiveness of the intervention to improve autonomy and job satisfaction.

Trial registration

ISRCTN registry, study ID: ISRCTN14697835, registration date: 11-10-2019 (retrospectively registered).

Hospital Medical and Nursing Managers' Perspectives on Health-Related Work Design Interventions. A Qualitative Study

BACKGROUND

Research indicates that the active support of managers is essential for the sustainable implementation of health-related work design interventions in organizations. However, little is known about managers' perceptions of such health promotion measures.

OBJECTIVE

Our study aims to provide information that help to foster managers active support of health-related work design interventions in hospitals. Based on Ajzen's Theory of Planned Behavior (TPB) we explore the attitudes, perceived organizational norms, and perceived behavioral control of managers in the hospital regarding such interventions.

METHODS

Semi-structured interviews with 37 managers (chief physicians, senior physicians, and senior nurses) were carried out in one German hospital. A software aided qualitative content analysis was applied.

RESULTS

We observed that the majority of managers are aware of the importance of health-related work design. We found a high variation in the perception of organizational norms related to mental health promotion of employees. Behavioral control for supporting interventions is perceived more on an individual (e.g., appraisal interviews, professional development or support) and team level (e.g., fair work schedule, regular team meetings), less on an organizational level.

CONCLUSION

To enable and to motivate hospital medical and nursing managers to support health-related work design, hospitals need to establish clear organizational norms that the health promotion of their employees is an important organizational goal. Moreover, managers need to get more work-design competencies and decision latitude to get more control. Important arguments for the top hospital management could be that health-related work design is highly effective for economic success, for treatment quality, and that the middle management already has a positive attitude toward the implementation of measures that help promote the mental health of their staff.

Study protocol of a co-created primary organizational-level intervention with the aim to improve organizational and social working conditions and decrease stress within the construction industry - a controlled trial

Background

Within construction industry, physical work exposures have long been recognized as possible determinants for musculoskeletal disorders, but less attention has been given the increasing organizational and social work hazards and stress within this industry. There is to date a lack of knowledge about how to improve organizational and social working conditions and decrease stress within the construction industry.

Methods

This paper outlines the design of a controlled trial to evaluate the effectiveness of a co-created organizational-level intervention with the aim to improve role clarity, quantitative demands, staffing, planning, team effectiveness, psychosocial safety climate and stress. Two regions (> 700 employees) within one large construction company in Sweden will participate as intervention and control group. Further we present the design of the process evaluation assessing fidelity, support from managers, readiness for change and contextual factors. We will utilize questionnaires, semi-structured interviews, observations and documentation as means for data collection, hence a mixed methods approach is applied.

Discussion

The study is expected to contribute to the understanding of how adverse organizational and social working conditions and stress can be improved within the construction industry. By applying co-creation we wish to develop an intervention and implementation strategies that fit to the context, are in line with the needs of end-users and are supported by all management levels - all of which are highlighted features in successful workplace interventions.

Trial registration

ISRCTN, ISRCTN16548039. Registered 12/02/20. Retrospectively registered

The design and development of a hybrid off-job crafting intervention to enhance needs satisfaction, well-being and performance: a study protocol for a randomized controlled trial

Background

Employees dealing with job demands such as high workload and permeable work-life boundaries could benefit from bottom-up well-being strategies such as off-job crafting. We have developed a hybrid off-job crafting intervention to promote off-job crafting, a proactive pursuit to adjust one’s off-job time activities to satisfy one’s psychological needs. This hybrid intervention contains both on-site (two trainings) and online elements (smartphone app) to enhance employees’ well-being and performance within different life domains.

Methods

The study is designed as a randomized controlled trial with an intervention group and a waitlist control group. The study population will be Finnish knowledge workers. The intervention program focuses on six psychological needs (detachment, relaxation, autonomy, mastery, meaning, and affiliation) proposed by the DRAMMA model. The intervention will consist of the following components: 1) an on-site off-job crafting training, 2) an individual off-job crafting plan for the four-week intervention period, 3) Everydaily smartphone app usage, and 4) a training session for reflection. The study outcomes are assessed with online questionnaires once at baseline, weekly during the intervention period and twice after the intervention (two-week and six-week follow-up). Moreover, during the second training session, participants will participate in a process evaluation to shed light on the mechanisms that can affect the effectiveness of the intervention.

Discussion

We expect that the intervention will stimulate off-job crafting behaviors, which may in turn increase well-being and performance in both non-work and work domains during and after the intervention (compared to baseline and to the control group). The intervention may provide employees with additional resources to deal with various stressors in life. Furthermore, this off-job crafting intervention could also offer performance benefits for the employers such as increased organizational citizenship behaviors among employees.

Trial registration

The Netherlands Trial Register (NTR): NL8219, December 9, 2019. Registered retrospectively. https://www.trialregister.nl/trial/8219

Humanitarian Aid Workers' Mental Health and Duty of Care

Set in challenging and complex environments, there has been growing concern about the mental health consequences of aid work. Along with existing difficulties in reducing well-known occupational risks such as exposure to trauma, there is a lack of awareness of psychosocial risks in the humanitarian sector. This paper is a discussion, drawing on occupational health perspectives, on ways to reflect on mental health policies, research and interventions in this sector.

Analysis of Needs and Processes: Social Skills Program for Unemployed People with Disabilities

Abstract This study evaluated indicators of needs and processes in a social skills program for unemployed people with physical disabilities. The needs assessment - measured via self-reporting instruments - indicated the importance of preparing participants for job interviews and improving some social skills related to work, which would serve as a basis for the definition of the program’s objectives. The skills developed in the program were as follows: civility, feedback, communication, empathy, offering help, citizenship, assertiveness, dealing with criticism, problem solving, job interview performance, and expressing positive feelings. For the process evaluation, the program’s sessions were filmed and analyzed using indicators such as task performance. This study showed the importance of planning a program that considers the characteristics of the participants and of continuously monitoring its application to ensure the suitability of the intervention and the achievement of its objectives.

Process Evaluation of a Stress Management Program for Low-Income Pregnant Women: The SMART Moms/Mamás LÍSTAS Project

Background. The SMART Moms/Mamás LÍSTAS Project was a randomized control trial that tested the efficacy of a prenatal stress management program in reducing stress and cortisol levels among low-income women. The current study is a process evaluation of the stress management program (intervention arm of the original randomized controlled trial) and assessed whether implementation fidelity factors (i.e., intervention delivery, receipt, and enactment) were associated with lower stress (perceived stress, salivary cortisol), improved negative and positive mood states (Positive and Negative Affect Schedule), and increased confidence to use relaxation and coping skills. Method. Fifty-five low-income pregnant women (71% Latina, 76% annual income <$20,000) attended weekly group-based sessions over an 8-week period in which a clinically trained researcher taught relaxation and coping skills. Process evaluation measures were obtained via participant self-report and videotaped class sessions that were coded for delivery, receipt, and enactment of the intervention to determine which implementation factors were associated with changes in program outcomes (stress, mood, confidence) over the 8-week period. Results. Women in stress management showed a significant reduction in their stress and cortisol levels (p < .001), improvements in negative and positive mood states (p < .001) and were more confident in using relaxation and coping skills postintervention (74%). The implementation factors of delivery (i.e., instructor adherence to intervention content; p = .03) and enactment (i.e., participant use of intervention skills; p = .02) were most associated with improvements in program outcomes. Conclusion. These findings highlight that implementation factors should be considered when delivering stress management interventions in underserved communities.

Mental Health Promotion Intervention for Nurses Working in German Psychiatric Hospital Departments: A Pilot Study

This pilot study aimed to implement a mental health promotion program to support nurses working in Psychiatric hospital departments. Eighty-six nurses working in psychiatric hospitals were randomized to either an intervention group (IG) or a waitlist control group (WCG). The intervention took place in groups over a period of 12 weeks. Training content included, i.e. work-related stress management training, problem solving techniques, and solution-focused counseling. Outcomes were measured at four times (baseline and three follow-up measurements). Perceived stress, coping skills, emotion regulation skills and changes in patient relationships were included as outcome measurements. Psychiatric nurses in the IG reported significant changes in perceived job stress, emotion regulation skills, resilience, and self-efficacy after the intervention. In addition, scores on quality of patient-relationship were significantly higher after the intervention (e.g. support, conflict management; p < 0.05). No comparable results could be found in the WCG. A mental health promotion intervention for psychiatric nurses was successfully implemented. Further research is necessary to generalize these pilot study findings.

Goal Pursuit in Organizational Health Interventions: The Role of Team Climate, Outcome Expectancy, and Implementation Intentions

In taking a goal pursuit perspective into account, the present study examined associations between the context, process and outcome evaluation of an organizational health intervention (OHI) implemented within 29 teams in a hospital setting. In doing so, team climate for innovation as a context factor was measured at baseline (N = 529). Four to six weeks after baseline, N = 250 team representatives participated in a 4-day workshop. During the workshop employees formulated collective goals as action plans to be implemented in the nursing wards. Goal pursuit as a process factor was differentiated into (a) a motivational “goal setting” and (b) a volitional “goal striving” phase. The scale of outcome expectancy (measured after the fourth day of the workshop) was used as an indicator for the goal setting phase. For the operationalization of the goal striving phase, action plans were coded with regard to the proportion of formulated implementation intentions (“if-then plans”). After 6 months, the outcome of the intervention was measured on a retrospective impact scale (N = 385). The results of the multiple regression analysis and of the multilevel analysis show that both team climate and goal pursuit (outcome expectancy and the proportion of if-then plans) were positively related to the perceived impact of the intervention. Furthermore, the results show that the relationship between team climate and the impact of the intervention was mediated by outcome expectancy. The results highlight the contribution of goal theory within context-process-outcome research that leads to a better understanding of when and why OHIs are effective.

Employees' and line managers' active involvement in participatory organizational interventions: Examining direct, reversed, and reciprocal effects on well-being

This study examined how employee participation and perceptions of line managers' support during a participatory organizational intervention were related to well-being over time. Although previous studies suggest that employees' and managers' active involvement in participatory organizational interventions may be related to well-being, little is known about the temporal aspects, such as at which time during the intervention these factors matter, or possible reciprocal effects. Building on conservation of resources theory, we tested hypotheses concerning direct, reversed, and reciprocal relationships between employee participation and perceptions of line manager support in relation to well-being. We used a four-wave panel design consisting of 159 hospital workers. Cross-lagged analyses showed that perceived line managers' support in the initiation and active phase was related to participation in the active phase. Participation in the initiation and active phase was related to well-being in the active and sustained phase, respectively. Results also revealed that participation in the initiation phase was related to perceived line managers' support in the active phase, which in turn predicted participation in the active phase, which translated into job satisfaction in the sustained phase supporting reversed and reciprocal effects in the form of resource caravans. Theoretical implications for research and practice are discussed.

School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review

BACKGROUND

Asthma is a common respiratory condition in children that is characterised by symptoms including wheeze, shortness of breath, chest tightness, and cough. Children with asthma may be able to manage their condition more effectively by improving inhaler technique, and by recognising and responding to symptoms. Schools offer a potentially supportive environment for delivering interventions aimed at improving self-management skills among children. The educational ethos aligns with skill and knowledge acquisition and makes it easier to reach children with asthma who do not regularly engage with primary care. Given the multi-faceted nature of self-management interventions, there is a need to understand the combination of intervention features that are associated with successful delivery of asthma self-management programmes.

OBJECTIVES

This review has two primary objectives.• To identify the intervention features that are aligned with successful intervention implementation.• To assess effectiveness of school-based interventions provided to improve asthma self-management among children.We addressed the first objective by performing qualitative comparative analysis (QCA), a synthesis method described in depth later, of process evaluation studies to identify the combination of intervention components and processes that are aligned with successful intervention implementation.We pursued the second objective by undertaking meta-analyses of outcomes reported by outcome evaluation studies. We explored the link between how well an intervention is implemented and its effectiveness by using separate models, as well as by undertaking additional subgroup analyses.

SEARCH METHODS

We searched the Cochrane Airways Trials Register for randomised studies. To identify eligible process evaluation studies, we searched MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Database of Systematic Reviews (CDSR), Web of Knowledge, the Database of Promoting Health Effectiveness Reviews (DoPHER), the Database of Abstracts of Reviews of Effects (DARE), the International Biography of Social Science (IBSS), Bibliomap, Health Technology Assessment (HTA), Applied Social Sciences Index and Abstracts (ASSIA), and Sociological Abstracts (SocAbs). We conducted the latest search on 28 August 2017.

SELECTION CRITERIA

Participants were school-aged children with asthma who received the intervention in school. Interventions were eligible if their purpose was to help children improve management of their asthma by increasing knowledge, enhancing skills, or changing behaviour. Studies relevant to our first objective could be based on an experimental or quasi-experimental design and could use qualitative or quantitative methods of data collection. For the second objective we included randomised controlled trials (RCTs) where children were allocated individually or in clusters (e.g. classrooms or schools) to self-management interventions or no intervention control.

DATA COLLECTION AND ANALYSIS

We used qualitative comparative analysis (QCA) to identify intervention features that lead to successful implementation of asthma self-management interventions. We measured implementation success by reviewing reports of attrition, intervention dosage, and treatment adherence, irrespective of effects of the interventions.To measure the effects of interventions, we combined data from eligible studies for our primary outcomes: admission to hospital, emergency department (ED) visits, absence from school, and days of restricted activity due to asthma symptoms. Secondary outcomes included unplanned visits to healthcare providers, daytime and night-time symptoms, use of reliever therapies, and health-related quality of life as measured by the Asthma Quality of Life Questionnaire (AQLQ).

MAIN RESULTS

We included 55 studies in the review. Thirty-three studies in 14,174 children provided information for the QCA, and 33 RCTs in 12,623 children measured the effects of interventions. Eleven studies contributed to both the QCA and the analysis of effectiveness. Most studies were conducted in North America in socially disadvantaged populations. High school students were better represented among studies contributing to the QCA than in studies contributing to effectiveness evaluations, which more commonly included younger elementary and junior high school students. The interventions all attempted to improve knowledge of asthma, its triggers, and stressed the importance of regular practitioner review, although there was variation in how they were delivered.QCA results highlighted the importance of an intervention being theory driven, along with the importance of factors such as parent involvement, child satisfaction, and running the intervention outside the child's own time as drivers of successful implementation.Compared with no intervention, school-based self-management interventions probably reduce mean hospitalisations by an average of about 0.16 admissions per child over 12 months (SMD -0.19, 95% CI -0.35 to -0.04; 1873 participants; 6 studies, moderate certainty evidence). They may reduce the number of children who visit EDs from 7.5% to 5.4% over 12 months (OR 0.70, 95% CI 0.53 to 0.92; 3883 participants; 13 studies, low certainty evidence), and probably reduce unplanned visits to hospitals or primary care from 26% to 21% at 6 to 9 months (OR 0.74, 95% CI 0.60 to 0.90; 3490 participants; 5 studies, moderate certainty evidence). Self-management interventions probably reduce the number of days of restricted activity by just under half a day over a two-week period (MD 0.38 days 95% CI -0.41 to -0.18; 1852 participants; 3 studies, moderate certainty evidence). Effects of interventions on school absence are uncertain due to the variation between the results of the studies (MD 0.4 fewer school days missed per year with self-management (-1.25 to 0.45; 4609 participants; 10 studies, low certainty evidence). Evidence is insufficient to show whether the requirement for reliever medications is affected by these interventions (OR 0.52, 95% CI 0.15 to 1.81; 437 participants; 2 studies; very low-certainty evidence). Self-management interventions probably improve children's asthma-related quality of life by a small amount (MD 0.36 units higher on the Paediatric AQLQ(95% CI 0.06 to 0.64; 2587 participants; 7 studies, moderate certainty evidence).

AUTHORS' CONCLUSIONS

School-based asthma self-management interventions probably reduce hospital admission and may slightly reduce ED attendance, although their impact on school attendance could not be measured reliably. They may also reduce the number of days where children experience asthma symptoms, and probably lead to small improvements in asthma-related quality of life. Many of the studies tested the intervention in younger children from socially disadvantaged populations. Interventions that had a theoretical framework, engaged parents and were run outside of children's free time were associated with successful implementation.

Line managers’ influence on employee usage of a web-based system for occupational health management

Purpose

The purpose of this paper is to investigate line managers’ influence on employee usage of a web-based system for occupational health management.

Design/methodology/approach

Questionnaires were used to measure line managers’ transformational leadership at baseline and their change-supportive managerial activities during weeks 16–52. Employee initial (weeks 16–52) and sustained (weeks 53–144) use of the web-based system was measured by extracting their frequency of logins to the system from electronic records. Data were collected from six white-collar organizations from 2011 through 2013. Mixed Poisson regressions were used to analyze the influence of transformational leadership and change-supportive managerial activities on employee usage.

Findings

As predicted, line managers’ change-supportive activities influenced the employees’ initial and sustained use of the system. Line managers’ transformational leadership had no direct effect on employees’ use of the system, however transformational leadership was indirectly associated with employees’ initial and sustained use of the system through line managers’ change-supportive activities.

Originality/value

The study adds to the understanding of the role line managers’ play during the implementation of occupational health interventions. The findings suggest that the line managers’ change-supportive activities directed toward the intervention are important for employees’ initial and sustained use of the system. The influence of transformational leadership was indirect, suggesting that line managers may need to direct their leadership behaviors toward the intervention to facilitate implementation.

Health-relevant personality traits in relation to adherence to a web-based occupational health promotion and stress management intervention

Purpose

The purpose of this paper is to investigate the possible associations between health-relevant personality traits and adherence; and if these traits predict adherence to a web-based occupational health intervention.

Design/methodology/approach

In total, 563 participants were analyzed using the Health-relevant Personality Inventory. Adherence measures were: logins, utilization of self-help exercises and time spent logged in.

Findings

Higher levels of antagonism (a facet of agreeableness) and impulsivity (a facet of conscientiousness) correlated to fewer logins, and higher levels of negative affectivity (a facet of neuroticism) and impulsivity correlated to a higher utilization of self-help exercises. Alexithymia (a facet of openness) negatively predicted self-help exercise utilization and antagonism was a positive predictor. Negative affectivity was a positive predictor of time spent logged in to the intervention. There were sex-related differences in outcomes.

Originality/value

This is the first study to investigate health-relevant personality traits in relation to adherence to a web-based occupational health intervention. The practical implications are that intervention developers could benefit from taking personality into consideration to better understand and improve adherence.

Work stress prevention needs of employees and supervisors

Background

Work stress prevention can reduce health risks for individuals, as well as organisational and societal costs. The success of work stress interventions depends on proper implementation. Failure to take into account the needs of employees and supervisors can hinder intervention implementation. This study aimed to explore employee and supervisor needs regarding organisational work stress prevention.

Methods

Semi-structured telephone interviews were conducted with employees (n = 7) and supervisors (n = 8) from different sectors, such as the finance, health care, and services industry. The interviews focused on respondents’ needs regarding the prevention of work stress within an organisational setting. Performing thematic analysis, topics and themes were extracted from the verbatim transcribed interviews using Atlas.ti.

Results

Both employees and supervisors reported a need for: 1) communication about work stress, 2) attention for determinants of work stress, 3) supportive circumstances (prerequisites) for work stress prevention, 4) involvement of various stakeholders in work stress prevention, and 5) availability of work stress prevention measures. Both employees and supervisors expressed the need for supervisors to communicate about work stress. Employees and supervisors reported similar psychosocial work factors that should be targeted for prevention (e.g., social support and autonomy). There was greater variety in the sub-themes within communication about work stress and supportive circumstances for work stress prevention in supervisor responses, and greater variety in the sub-themes within availability of work stress prevention measures in employee responses.

Conclusions

Both employees and supervisors were explicit about who should take part in communication about work stress, what prerequisites for work stress prevention should exist, and which stakeholders should be involved. These results can inform work stress prevention practice, supporting selection and implementation of interventions.

Trial registration

This study was registered in the Netherlands National Trial Register, trial code: NTR5527.

Process evaluation of a participatory organizational change program to reduce musculoskeletal and slip, trip and fall injuries

BACKGROUND

Long-term care (LTC) workers are at significant risk for occupational-related injuries. Our objective was to evaluate the implementation process of a participatory change program to reduce risk.

METHODS

A process evaluation was conducted in three LTC sites using a qualitative approach employing structured interviews, consultant logs and a focus group.

RESULTS

Findings revealed recruitment/reach themes of being "voluntold", using established methods, and challenges related to work schedules. Additional themes about dose were related to communication, iterative solution development, participation and engagement. For program fidelity and satisfaction, themes emerged around engagement, capacity building and time demands.

CONCLUSION

Process evaluation revealed idiosyncratic approaches to recruitment and related challenges of reaching staff. Solutions to prioritized hazards were developed and implemented, despite time challenges. The iterative solution development approach was embraced. Program fidelity was considered good despite early program time demands. Post implementation reports revealed sustained hazard identification and solution development.

Implementation of an ergonomics intervention in a Swedish flight baggage handling company-A process evaluation

Objective

To conduct a process evaluation of the implementation of an ergonomics training program aimed at increasing the use of loading assist devices in flight baggage handling.

Methods

Feasibility related to the process items recruitment, reach, context, dose delivered (training time and content); dose received (participants’ engagement); satisfaction with training; intermediate outcomes (skills, confidence and behaviors); and barriers and facilitators of the training intervention were assessed by qualitative and quantitative methods.

Results

Implementation proved successful regarding dose delivered, dose received and satisfaction. Confidence among participants in the training program in using and talking about devices, observed use of devices among colleagues, and internal feedback on work behavior increased significantly (p<0.01). Main facilitators were self-efficacy, motivation, and perceived utility of training among the trainees. Barriers included lack of peer support, opportunities to observe and practice behaviors, and follow-up activities; as well as staff reduction and job insecurity.

Conclusions

In identifying important barriers and facilitators for a successful outcome, this study can help supporting the effectiveness of future interventions. Our results suggest that barriers caused by organizational changes may likely be alleviated by recruiting motivated trainees and securing strong organizational support for the implementation.

Experiences of occupational physicians with the implementation of indicated prevention for long term sickness absence

BACKGROUND

Functioning including work participation, is an emerging challenge in occupational health. The prevention of long term sickness absence (LTSA) through a strategy involving screening and structured early consultation (preventive strategy) was proven effective and can address participation issues. Implementation of this strategy has proven difficult.

OBJECTIVE

The aim of this study is to investigate the experiences of occupational physicians (OPs) delivering a structured early consultation to office workers, in order to enhance implementation of the strategy.

METHODS

In this case study, a mixed method design was used. Interviews and surveys were conducted to obtain an in-depth picture of OPs experiences.

RESULTS

Factors hindering implementation in relation to the OPs were difficulties in communicating the risk of future sick leave, prioritization of other tasks, maintaining a reactive approach due to work pressure, preference for prevention on the level of the work environment, privacy issues related to labeling workers to have mental or psychosocial issues, and the biomedical model being the mental model in use.

CONCLUSIONS

Implementation of the preventive strategy seems to require a more profound focus on the biopsychosocial approach. Training of relevant skills is important to achieve a focus on prevention and fostering health over the lifespan.

Trajectories of well-being during an exercise randomized controlled trial: The role of exposure and exercise experiences

We examined how process factors were related to the development of various indicators of well-being during the course of an exercise randomized controlled trial aimed at reducing fatigue among university students. We investigated (a) whether actual exposure to the exercise sessions was related to differences in students' trajectories of well-being, (b) the minimally required exposure to exercise needed before well-being started to differ between the intervention and control condition, and (c) whether exercise experiences (enjoyment and detachment) were related to differences in well-being trajectories. University students with high levels of fatigue were randomly allocated to a 6-week exercise intervention (n = 50) or wait list (n = 49). All participants were measured before, 5 times during, and at the end of the intervention period. Multilevel analyses showed that exercisers with high exposure showed an increase in self-efficacy whereas those with low exposure did not. Effects of exercise on well-being became visible after 2 to 4 weeks during the intervention period and (partly) depended on the extent of psychological detachment. We recommend that both outcomes and process factors throughout the intervention period should be measured in order to better understand "when" and "under what conditions" an exercise intervention works.

Steps to Ensure a Successful Implementation of Occupational Health and Safety Interventions at an Organizational Level

There is increasing meta-analytic evidence that addresses the positive impact of evidence-based occupational health and safety interventions on employee health and well-being. However, such evidence is less clear when interventions are approached at an organizational level and are aimed at changing organizational policies and processes. Given that occupational health and safety interventions are usually tailored to specific organizational contexts, generalizing and transferring such interventions to other organizations is a complex endeavor. In response, several authors have argued that an evaluation of the implementation process is crucial for assessing the intervention's effectiveness and for understanding how and why the intervention has been (un)successful. Thus, this paper focuses on the implementation process and attempts to move this field forward by identifying the main factors that contribute toward ensuring a greater success of occupational health and safety interventions conducted at the organizational level. In doing so, we propose some steps that can guide a successful implementation. These implementation steps are illustrated using examples of evidence-based best practices reported in the literature that have described and systematically evaluated the implementation process behind their interventions during the last decade.

Caring for the elderly at work and home: Can a randomized organizational intervention improve psychological health?

Although job stress models suggest that changing the work social environment to increase job resources improves psychological health, many intervention studies have weak designs and overlook influences of family caregiving demands. We tested the effects of an organizational intervention designed to increase supervisor social support for work and nonwork roles, and job control in a results-oriented work environment on the stress and psychological distress of health care employees who care for the elderly, while simultaneously considering their own family caregiving responsibilities. Using a group-randomized organizational field trial with an intent-to-treat design, 420 caregivers in 15 intervention extended-care nursing facilities were compared with 511 caregivers in 15 control facilities at 4 measurement times: preintervention and 6, 12, and 18 months. There were no main intervention effects showing improvements in stress and psychological distress when comparing intervention with control sites. Moderation analyses indicate that the intervention was more effective in reducing stress and psychological distress for caregivers who were also caring for other family members off the job (those with elders and those "sandwiched" with both child and elder caregiving responsibilities) compared with employees without caregiving demands. These findings extend previous studies by showing that the effect of organizational interventions designed to increase job resources to improve psychological health varies according to differences in nonwork caregiving demands. This research suggests that caregivers, especially those with "double-duty" elder caregiving at home and work and "triple-duty" responsibilities, including child care, may benefit from interventions designed to increase work-nonwork social support and job control. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Systematic review of the association between physical activity and burnout

Objective:

Burnout constitutes a health risk, and interventions are needed to reduce it. The aim of this study was to synthesize evidence regarding the relationship between physical activity and burnout by conducting a systematic review of longitudinal and intervention studies.

Methods:

A literature search resulted in the identification of a final set of ten studies: four longitudinal and six intervention studies. In separate analyses for each category, evidence was synthesized by extracting the study characteristics and assessing the methodological quality of each study. The strength of evidence was calculated with the standardized index of convergence (SIC).

Results:

In longitudinal studies, we found moderately strong evidence (SIC (4) = -1) for a negative relationship between physical activity and the key component of burnout, i.e., exhaustion. We found strong evidence (SIC (6) = -0.86) for the effect of physical activity on reducing exhaustion in intervention studies. As only one study could be classified as a high quality study, these results of previous studies need to be interpreted with some caution.

Conclusions:

This systematic review suggests that physical activity constitutes an effective medium for the reduction of burnout. Although consistent evidence was found, there is a lack of high quality longitudinal and intervention studies considering the influence of physical activity on burnout. Therefore, future research should be conducted with the aim to produce high quality studies, to develop a full picture of physical activity as a strategy to reduce burnout.

The relevance of intervention participants’ process appraisal for change in well-being and lean work processes of entire teams

Purpose

The purpose of this paper is to investigate whether intervention participants’ process appraisals relate to change in well-being and lean outcomes of entire teams. For this purpose, the study focussed on two main characteristics of a lean implementation process – workshop quality and outcome expectancy – and their interaction with the participation rate, and examined their association with leaner work processes and affective well-being in nursing teams.

Design/methodology/approach

Data were collected from a lean implementation project within 29 nursing wards of a university hospital. Employee surveys covering lean work processes and affective well-being at work were conducted before the implementation of four-day lean workshops in each nursing ward and six months after. The participating employee representatives evaluated the workshop quality and outcome expectancy of the workshops.

Findings

Multilevel analyses indicated that workshop quality did not relate to leaner work processes, but was associated with enhanced affective well-being after six months. By contrast, outcome expectancy was associated with leaner work processes, but did not relate to well-being. No moderation effects with participation rate were found.

Practical implications

The study shows the importance of monitoring process indicators in the early stages of implementation and optimising workshop contents and formats accordingly to ensure positive outcomes for entire teams.

Originality/value

The present study considers intervention participants’ process appraisals of workshop quality and outcome expectancy as good indicators of future change in lean work processes and the well-being of entire teams.

Evaluating the implementation process of a participatory organizational level occupational health intervention in schools

BACKGROUND

The importance of process evaluations in examining how and why interventions are (un) successful is increasingly recognized. Process evaluations mainly studied the implementation process and the quality of the implementation (fidelity). However, in adopting this approach for participatory organizational level occupational health interventions, important aspects such as context and participants perceptions are missing. Our objective was to systematically describe the implementation process of a participatory organizational level occupational health intervention aimed at reducing work stress and increasing vitality in two schools by applying a framework that covers aspects of the intervention and its implementation as well as the context and participants perceptions.

METHODS

A program theory was developed, describing the requirements for successful implementation. Each requirement was operationalized by making use of the framework, covering: initiation, communication, participation, fidelity, reach, communication, satisfaction, management support, targeting, delivery, exposure, culture, conditions, readiness for change and perceptions. The requirements were assessed by quantitative and qualitative data, collected at 12 and 24 months after baseline in both schools (questionnaire and interviews) or continuously (logbooks).

RESULTS

The intervention consisted of a needs assessment phase and a phase of implementing intervention activities. The needs assessment phase was implemented successfully in school A, but not in school B where participation and readiness for change were insufficient. In the second phase, several intervention activities were implemented at school A, whereas this was only partly the case in school B (delivery). In both schools, however, participants felt not involved in the choice of intervention activities (targeting, participation, support), resulting in a negative perception of and only partial exposure to the intervention activities. Conditions, culture and events hindered the implementation of intervention activities in both schools.

CONCLUSIONS

The framework helped us to understand why the implementation process was not successful. It is therefore considered of added value for the evaluation of implementation processes in participatory organizational level interventions, foremost because of the context and mental models dimensions. However, less demanding methods for doing detailed process evaluations need to be developed. This can only be done if we know more about the most important process components and this study contributes to that knowledge base.

TRIAL REGISTRATION

Netherlands Trial Register NTR3284 .

Sustaining Work Participation Across the Life Course

Introduction Many disability prevention strategies are focused on acute injuries and brief illness episodes, but there will be growing challenges for employers to manage circumstances of recurrent, chronic, or fluctuating symptoms in an aging workforce. The goal of this article is to summarize existing peer-review research in this area, compare this with employer discourse in the grey literature, and recommend future research priorities. Methods The authors participated in a year-long sponsored collaboration that ultimately led to an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability", held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the scientific and industry literature, group discussion to identify key areas and challenges, drafting of initial documents, and feedback from peer researchers and a special panel of experts with employer experience. Results Cancer and mental illness were chosen as examples of chronic or recurring conditions that might challenge conventional workplace return-to-work practices. Workplace problems identified in the literature included fatigue, emotional exhaustion, poor supervisor and co-worker support, stigma, discrimination, and difficulties finding appropriate accommodations. Workplace intervention research is generally lacking, but there is preliminary support for improving workplace self-management strategies, collaborative problem-solving, and providing checklists and other tools for job accommodation, ideas echoed in the literature directed toward employers. Research might be improved by following workers from an earlier stage of developing workplace concerns. Conclusions Future research of work disability should focus on earlier identification of at-risk workers with chronic conditions, the use of more innovative and flexible accommodation strategies matched to specific functional losses, stronger integration of the workplace into on-going rehabilitation efforts, and a better understanding of stigma and other social factors at work.

Process evaluations in neurological rehabilitation: a mixed-evidence systematic review and recommendations for future research

OBJECTIVE

To systematically review how process evaluations are currently designed, what methodologies are used and how are they developed alongside or within neurological rehabilitation trials.

METHODS

This mixed-methods systematic review had two evidence streams: stream I, studies reporting process evaluations alongside neurorehabilitation trials research and stream II, methodological guidance on process evaluation design and methodology. A search strategy was designed for each evidence stream. Data regarding process evaluation core concepts and design issues were extracted using a bespoke template. Evidence from both streams was analysed separately and then synthesised in a final overarching synthesis proposing a number of recommendations for future research.

RESULTS

A total of 124 process evaluation studies, reporting on 106 interventions, were included in stream I evidence. 30 studies were included as stream II evidence. Synthesis 1 produced 9 themes, and synthesis 2 identified a total of 8 recommendations for process evaluation research. The overall synthesis resulted in 57 'synthesis recommendations' about process evaluation methodology grouped into 9 research areas, including the use of theory, the investigation of context, intervention staff characteristics and the delivery of the trial intervention.

CONCLUSIONS

There remains no consensus regarding process evaluation terminology within the neurological rehabilitation field. There is a need for process evaluations to address the nature and influence of context over time. Process evaluations should clearly describe what intervention staff bring to a trial, including skills and experience prior to joining the research. Process evaluations should monitor intervention staff's learning effects and the possible impact that these may have on trial outcomes.

Evaluation of self-care skills training and solution-focused counselling for health professionals in psychiatric medicine: a pilot study

OBJECTIVE

The purpose of this pilot study was to implement and to evaluate a self-care skills training with solution-focused counselling to support psychiatrists in handling their daily work challenges.

METHODS

A total of 72 psychiatrists working in a psychiatric clinic were randomised in a single-blind trial to either an intervention group or a control group. Outcomes were measured at baseline and at the end of the training (follow-up 1: after 3 months; follow-up 2: after 6 months). A validated questionnaire including the Perceived Stress Questionnaire, the Copenhagen Psychosocial Questionnaire, Brief Resilient Coping Scale, Self-Efficacy Scale and the Quality of Relationship Inventory was used.

RESULTS

Psychiatrists in the intervention group reached a significant reduction in perceived job stress (p = 0.01, d = 0.05), improvements in job satisfaction (p = 0.02, d = 0.04), resilience (p = 0.02, d = 0.04) and self-efficacy (p = 0.04, d = 0.02) from baseline to all follow-ups with no comparable results seen in the control group. Psychiatrists stated an improved quality of physician-patient relationship (e.g. support, conflict management; p < 0.05).

CONCLUSIONS

A self-care skills training, including solution-focused counselling, for psychiatrists was associated with significant improvements in perceived stress, job satisfaction, individual protective skills and quality of relationship to patients. This training is suitable to implement as a group training program for psychiatrists.

Work Site-Based Environmental Interventions to Reduce Sedentary Behavior: A Systematic Review

OBJECTIVE

The purpose of this investigation was to systematically review work site-based, environmental interventions to reduce sedentary behavior following preferred reporting items for systematic reviews and meta-analyses guidelines.

DATA SOURCE

Data were extracted from Medical Literature Analysis and Retrieval System Online, Cochrane Central Register of Controlled Trials, and Web of Science between January 2005 and December 2015.

STUDY INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria were work site interventions, published in peer-reviewed journals, employing environmental modalities, targeting sedentary behavior, and using any quantitative design. Exclusion criteria were noninterventions and non-English publications.

DATA EXTRACTION

Data extracted included study design, population, intervention dosage, intervention activities, evaluation measures, and intervention effects.

DATA SYNTHESIS

Data were tabulated quantitatively and synthesized qualitatively.

RESULTS

A total of 15 articles were identified for review and 14 reported statistically significant decreases in sedentary behavior. The majority of studies employed a randomized controlled trial design (n = 7), used inclinometers to measure sedentary behavior (n = 9), recruited predominantly female samples (n = 15), and utilized sit-to-stand desks as the primary intervention modality (n = 10). The mean methodological quality score was 6.2 out of 10.

CONCLUSION

Environmental work site interventions to reduce sedentary behavior show promise because work sites often have more control over environmental factors. Limitations of this intervention stream include inconsistent measurement of sedentary behavior, absence of theoretical frameworks to guide program development, and absence of long-term evaluation. Future studies should include clear reporting of intervention strategies and explicit operationalization of theoretical constructs.

Are We All in the Same Boat? The Role of Perceptual Distance in Organizational Health Interventions

The study investigates how agreement between leaders' and their team's perceptions influence intervention outcomes in a leadership-training intervention aimed at improving organizational learning. Agreement, i.e. perceptual distance was calculated for the organizational learning dimensions at baseline. Changes in the dimensions from pre-intervention to post-intervention were evaluated using polynomial regression analysis with response surface analysis. The general pattern of the results indicated that the organizational learning improved when leaders and their teams agreed on the level of organizational learning prior to the intervention. The improvement was greatest when the leader's and the team's perceptions at baseline were aligned and high rather than aligned and low. The least beneficial scenario was when the leader's perceptions were higher than the team's perceptions. These results give insights into the importance of comparing leaders' and their team's perceptions in intervention research. Polynomial regression analyses with response surface methodology allow three-dimensional examination of relationship between two predictor variables and an outcome. This contributes with knowledge on how combination of predictor variables may affect outcome and allows studies of potential non-linearity relating to the outcome. Future studies could use these methods in process evaluation of interventions. Copyright © 2016 John Wiley & Sons, Ltd.

How to Measure the Intervention Process? An Assessment of Qualitative and Quantitative Approaches to Data Collection in the Process Evaluation of Organizational Interventions

Organizational interventions aiming at improving employee health and wellbeing have proven to be challenging to evaluate. To analyze intervention processes two methodological approaches have widely been used: quantitative (often questionnaire data), or qualitative (often interviews). Both methods are established tools, but their distinct epistemological properties enable them to illuminate different aspects of organizational interventions. In this paper, we use the quantitative and qualitative process data from an organizational intervention conducted in a national postal service, where the Intervention Process Measure questionnaire (N = 285) as well as an extensive interview study (N = 50) were used. We analyze what type of knowledge about intervention processes these two methodologies provide and discuss strengths and weaknesses as well as potentials for mixed methods evaluation methodologies.