Adaptation and implementation of an employee mental health disclosure decision aid tool in a real-world sample

Making decisions about disclosing mental health conditions in the workplace is complicated. A previous randomized controlled trial showed that web-based decision aid tool (READY?) helped employees make decisions and improved mental health. We aimed to evaluate the implementation of this tool and its outcomes when scaled up by a governmental health and safety agency. We used website analytics and event data of those using the decision aid tool, and self-report stage of decision-making, distress, engagement, and usability data from consenting users of READY? over the first year of it being made publicly available. Over the year 2021, 100 adults opted in to be involved in the research evaluation of the program. This study replicated the previous Randomised Controlled Trial (RCT) that showed at post-intervention; a later stage of decision-making (t1,99 = 6.308, P < .001) with a large effect size (d = 0.87), and psychological distress was significantly reduced (t1,99 = 3.088, P < .001) with a moderate effect size (d = 0.41). READY? facilitated disclosure with 36.3% deciding to disclose after use. Disclosure was associated with a greater reduction in mental ill-health symptoms than non-disclosure [F(2,31) = 18.67, P < .001] with a moderate effect size (d = 0.64). Engagement, usage, and attrition rates were favourable when compared with other digital mental health approaches in community samples. This study shows that READY? is successfully implemented in a real-world sample. Aligning with the RCT results, for many, disclosure can be positive, research should continue to focus on developing organization-wide tools to create better supported and safe workplaces that promote disclosure.

Developing a Decision Aid Tool for selecting pen-paper observational ergonomics techniques: a quasi-experimental study

BACKGROUND

A significant error that may occur during ergonomic risk assessment and invalidate assessment reliability corresponds to technique selection. This study aimed to develop a new tool called the Decision Aid Tool (DAT) to reduce pen-paper observational technique selection errors.

METHODS

This quasi-experiment before-after study was performed in three phases. In the first phase, the participants' skills in technique selection were examined by showing them 20 videos of different single-task jobs. In the second phase, the DAT was designed using pen-paper observational techniques. Finally, in the third phase, 115 occupational health specialists included in the study through purposive sampling of experts evaluated the tool's efficacy.

RESULTS

The results of the first phase showed that 62% of participants made an error in selecting the proper technique. The mean and standard deviation scores from the first and third phases were 11.4 ± 6.59 and 39.01 ±1.89, respectively. The mean scores increased significantly after using DAT, and 97.5% of participants could correctly select task techniques.

CONCLUSIONS

The efficacy of DAT was confirmed in a quasi-experimental before-and-after study. Using DAT increases the participants' ability to choose the correct technique. The DAT can be functional for practitioners to select the pen-paper observational techniques correctly under the purpose of assessment, the body areas, and the characteristics of the task to be assessed.

Patient-Tailored Levothyroxine Dosage with Pharmacokinetic/Pharmacodynamic Modeling: A Novel Approach After Total Thyroidectomy

Background: After seven decades of levothyroxine (LT4) replacement therapy, dosage adjustment still takes several months. We have developed a decision aid tool (DAT) that models LT4 pharmacometrics and enables patient-tailored dosage. The aim of this was to speed up dosage adjustments for patients after total thyroidectomy. Methods: The DAT computer program was developed with a group of 46 patients post-thyroidectomy, and it was then applied in a prospective randomized multicenter validation trial in 145 unselected patients admitted for total thyroidectomy for goiter, differentiated thyroid cancer, or thyrotoxicosis. The LT4 dosage was adjusted after only two weeks, with or without application of the DAT, which calculated individual free thyroxine (fT4) targets based on four repeated measurements of fT4 and thyrotropin (TSH) levels. The individual TSH target was either <0.1, 0.1-0.5, or 0.5-2.0 mIU/L, depending on the diagnosis. Initial postoperative LT4 dosage was determined according to clinical routine without using algorithms. A simplified DAT with a population-based fT4 target was used for thyrotoxic patients who often went into surgery after prolonged TSH suppression. Subsequent LT4 adjustments were carried out every six weeks until target TSH was achieved. Results: When clinicians were guided by the DAT, 40% of patients with goiter and 59% of patients with cancer satisfied the narrow TSH targets eight weeks after surgery, as compared with only 0% and 19% of the controls, respectively. The TSH was within the normal range in 80% of DAT/goiter patients eight weeks after surgery as compared with 19% of controls. The DAT shortened the average dosage adjustment period by 58 days in the goiter group and 40 days in the cancer group. For thyrotoxic patients, application of the simplified DAT did not improve the dosage adjustment. Conclusions: Application of the DAT in combination with early postoperative TSH and fT4 monitoring offers a fast approach to LT4 dosage after total thyroidectomy for patients with goiter or differentiated thyroid cancer. Estimation of individual TSH-fT4 dynamics was crucial for the model to work, as removal of this feature in the applied model for thyrotoxic patients also removed the benefit of the DAT.

Co-Designing a Web-Based Decision Aid Tool for Employees Disclosure of Mental Health Conditions: A Participatory Study Design Using Employee and Organizational Preferences

BACKGROUND

Decisions of whether to disclose mental health conditions are extremely personal and require the consideration of multiple factors associated with the disclosure process (eg, weighing the risks and benefits). Decision aid tools help people make these complex decisions. Such an aid needs to be confidential, easily accessible, and easy to use with the potential to access the tool on multiple occasions. Web programs are well suited to meet these requirements and, if properly developed, can provide feasible, accessible, affordable, and effective workplace interventions.

OBJECTIVE

This study aims to gain insights from potential end users, in this case both employees and organizations, into what type of components including language, style, and content would avoid potential stigma and ensure that elements of clear value for users would be built into a web-based decision aid tool that aims to assist employees in making decisions about the disclosure of their mental health condition at work.

METHODS

A participatory design approach was used to allow developers, researchers, experts, and end users to collaborate in co-designing the tool. During the user research phase of the development of the web-based tool, a participatory design workshop approach was selected as a part of a larger study of focus groups. Australian employees and managers in rural, suburban, and urban locations participated in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for a decision aid tool.

RESULTS

A total of 2 workshops were conducted with 13 participants. The majority were from a transport company (9/13, 69%), male (8/13, 62%), and employed full time (11/13, 85%). Six employees had previous experience disclosing their own mental health condition, and 7 were in a supervisory role and had previously been disclosed to. In any co-design development, there are certain trade-offs that need to be made between the views of experts, developers, end users, and the available budget. In this specific instance of a very delicate, personal decision, the end users provided valuable design insights into key areas such as language, and they were very antipathetic to a key feature, the avatar, which was thought to be desirable by experts and developers. Findings including aspects of the tool where all stakeholders were in agreement, aspects where some stakeholders disagreed and adaptations were implemented, where disagreements could not be implemented because of financial constraints, and misalignment between stakeholders and how to decide on a balance were shared.

CONCLUSIONS

The co-design with a lived experience approach is useful for contributing much to the design, language, and features. The key in this study was balancing the needs of the workers and the potential impact for the managers and organizations, while ensuring legislation and regulation requirements were upheld.

Deciding to Disclose a Mental Health Condition in Male Dominated Workplaces; A Focus-Group Study

Objectives: Deciding to disclose a mental illness in the workplace requires thoughtful informed decision making. Decision aids are increasingly used to help people make complex decisions, but need to incorporate relevant factors for the context. This study aimed to identify factors and processes that influence decision making about such disclosure to inform the development of a disclosure decision aid tool for employees in male dominated industries. Methods: We invited 15 partner organisations in male dominated industries to facilitate the recruitment of employees who either had disclosed a mental health condition in their workplace; or occupied a position to whom employees disclosed to focus groups addressing the aims. Results: The majority of the organisations had explicit policies that employees must disclose and so were unable to be seen countenancing non-disclosure as an option. Two focus groups were conducted (n = 13) with mainly male (62%), full-time employees (85%), and both disclosed (46%) and authority (54%) groups. Six themes, all barriers, were identified as influencing decision making processes: knowledge about symptoms, and self-discrimination (internal), stigma and discrimination by others, limited managerial support, dissatisfaction with services, and/or a risk of job or financial loss (external). Conclusion: Decisions to disclose mental health conditions, even by those who had done so, appear driven entirely by consideration of negative aspects. This suggests that anti-discrimination policy, legislation, awareness campaigns, and manager training have yet to change negative perceptions, and that any decision aid tool needs to incorporate counterfactual positive aspects that appear not to be an important consideration in such male dominated workplaces. There is a disconnect between organisational policies favouring disclosure and employees favouring non-disclosure that has caused tension within the organisational culture. Decision aid tools may assist employees with an active disclosure without waiting for an event to occur, giving the control of the decision back to the employee.