Improving Employee Well-Being and Effectiveness: Systematic Review and Meta-Analysis of Web-Based Psychological Interventions Delivered in the Workplace

Effectiveness of an integrated platform-based intervention for promoting psychosocial safety climate and mental health in nursing staff: A pragmatic cluster randomised controlled trial

BACKGROUND

Organisational and individual factors cause strain in the daily lives of nurses and other healthcare professionals, who have a high prevalence of stress-related disorders. Accordingly, there is a strong need for integrated occupational health promotion interventions that include both work-directed and person-directed interventions. The psychosocial safety climate is seen as an overarching occupational health objective and can potentially be improved by implementing integrated mental health interventions.

OBJECTIVE

Following an integrated approach, we developed an occupational e-mental health platform, Care4Care, which integrates both work- and person-directed interventions for promoting mental health in nurses. We evaluated the effects of the platform compared with those of an extended care-as-usual control condition.

DESIGN

Clustered randomised controlled trial.

SETTING

Healthcare service facilities in Germany nationwide.

PARTICIPANTS

347 nursing staff members (intervention: 211, control: 136) from 33 healthcare service facilities.

METHODS

The participants received either immediate access to the platform or access to two short subcomponents of the platform plus routine occupational health promotion offerings as well as delayed access to the whole platform after 6 months. The primary outcome was improvement in the psychosocial safety climate after 6 months. The secondary outcomes included perceived stress, depressive symptoms, and other strain-related indicators.

RESULTS

Bayesian multilevel analyses revealed an improvement of approximately 2 points (Cohen's d = 0.25) in the psychosocial safety climate in the intervention group compared with the control group. Applying a 95 % credible interval, this effect contained zero (-0.32, 4.44), which indicated uncertainty about the effectiveness of the intervention on the psychosocial safety climate. The analyses of the secondary outcomes revealed effects in the expected direction with high credibility for a decreasing effect on perceived stress and considerable uncertainty with regard to all other secondary and tertiary outcomes. A total of 85 (40 %) participants in the intervention group used Care4Care, whereas 37 (27 %) participants in the control group used the two subcomponents of the platform.

CONCLUSIONS

This study highlights the potential of an occupational e-mental health platform that combines work- and person-directed interventions with face-to-face components for nursing staff. The findings emphasise the necessity of conducting more in-depth implementation studies to identify the factors that facilitate the successful implementation and uptake of occupational e-mental health platforms.

REGISTRATION

German Clinical Trials Register - DRKS (DRKS00027869). Registration date: February 23, 2022. Start of recruitment: June 21, 2022.

Employee Preference and Use of Employee Mental Health Programs: Mixed Methods Study

BACKGROUND

Mental health issues represent a prevalent challenge for employees and their employers, leading to substantial impacts on individuals, society, and the economy. Different employee mental health programs (EMHPs) can support employees in preventing and treating mental health issues. However, the impact of such EMHPs depends largely on the use behavior of employees.

OBJECTIVE

This study aimed to gain deeper insights into employees' attitude and use behavior regarding EMHPs by investigating (1) employee preference and intention to use EMHPs, (2) factors that predict use, and (3) key facilitators and barriers influencing use.

METHODS

An exploratory sequential mixed methods approach was applied, including a scoping review, qualitative interviews, and a quantitative web-based survey. Semistructured qualitative interviews were conducted with 15 employees to gain insights into EMHPs from the employee perspective and inform the creation of a web-based questionnaire. The quantitative web-based survey was conducted to collect representative primary data on employees' perspectives on different EMHPs using 7-point Likert scales. The collected quantitative data were analyzed through descriptive and inferential statistics, including repeated measures ANOVAs and chi-square tests.

RESULTS

The final sample of the web-based survey consisted of 1134 participants and was representative across several sociodemographic characteristics. Analysis of the sample revealed that when given the choice, employees preferred digital (n=666, 58.73%) and self-intervention (n=590, 52.03%) EMHPs. Employees were most likely to use EMHPs focused on prevention (mean 4.89, SD 1.61). Intention to use EMHPs was predicted by age (young: mean 4.59, SD 1.2; old: mean 4.19, SD 1.4; P<.001; Cohen d=0.32), education (academic degree: mean 4.68, SD 1.24; no academic degree: mean 4.26, SD 1.32; P<.001; Cohen d=0.32), and mostly by company culture (positive company culture: mean 4.61, SD 1.27; negative company culture: mean 3.99, SD 1.27; P<.001; Cohen d=0.49). Cost coverage (n=345, 30.42%) and ease of use (n=337, 29.72%) were critical facilitators of use.

CONCLUSIONS

Employers can have a positive contribution to employee mental health by starting to offer EMHPs, preferably digital self-intervention programs for prevention; creating and maintaining the right work environment and culture; and ensuring cost coverage for the EMHP.

Digital Wellness Programs in the Workplace: Meta-Review

BACKGROUND

Corporate wellness programs are increasingly using digital technologies to promote employee health. Digital wellness programs (DWPs) refer to initiatives that deliver health interventions through digital tools. Despite a growing body of evidence on DWPs, the literature remains fragmented across multiple health domains.

OBJECTIVE

This study aims to provide a comprehensive synthesis of existing research on the efficacy (eg, impact on employee's physical health, mental well-being, behavioral changes, and absenteeism) and acceptability (eg, engagement, perceived usefulness, and adoption) of employer-provided DWPs. Specifically, we aim to map the extent, range, and nature of research on this topic; summarize key findings; identify gaps; and facilitate knowledge dissemination.

METHODS

We conducted a meta-review of studies published between 2000 and 2023. We adopted a database-driven search approach, including the MEDLINE, PsycINFO, ProQuest Central, and Web of Science Core Collection databases. The inclusion criteria consisted of (1) review articles; (2) publications in English, French, or German; (3) studies reporting on digital health interventions implemented in organizations; (4) studies reporting on nonclinical or preclinical employee populations; and (5) studies assessing the efficacy and acceptability of employer-provided DWPs. We performed a descriptive numerical summary and thematic analysis of the included studies.

RESULTS

Out of 593 nonduplicate studies screened, 29 met the inclusion criteria. The most investigated health domains included mental health (n=19), physical activity (n=8), weight management (n=6), unhealthy behavior change (n=4), and sleep management (n=2). In total, 24 reviews focused on the efficacy of DWPs, primarily in relation to health-related outcomes (eg, stress and weight), while fewer reviews addressed organization-related outcomes (eg, burnout and absenteeism). Four reviews explored the mechanisms of action, and 3 assessed the acceptability of DWPs using various measures. Overall, the findings support the efficacy and acceptability of DWPs, although significant gaps persist, particularly regarding the durability of outcomes, the role of technology, and the causal mechanisms underlying behavioral change.

CONCLUSIONS

While DWPs show promise across a variety of health domains, several aspects of their effectiveness remain underexplored. Practitioners should capitalize on existing evidence of successful DWPs while acknowledging the limitations in the literature.

Health status in the era of digital transformation and sustainable economic development

BACKGROUND

In the contemporary landscape characterized by digital transformation and sustainable economic development, understanding the dynamics of health status is critically significant. This study investigates the complex relationship among healthcare expenditure, digital transformation, health status, and well-being within the European Union (EU) framework.

METHODS

Through structural equation modeling, the research examines the multidimensional interplay among these variables, while cluster analysis supports identifying distinct patterns within the data. The paper aims to provide a broad understanding of the impact of digital transformation and healthcare expenditure on health status and well-being at the EU level.

RESULTS

The findings unveil nuanced linkages among healthcare expenditure, digital transformation, health status, and well-being across distinct clusters of EU countries. While certain countries exhibit synergistic advancements resulting in enhanced healthcare outcomes, others confront challenges stemming from disparities in digital infrastructure, healthcare expenditure allocation, and health status.

CONCLUSIONS

This study underscores the imperative of fostering synergies between digital transformation and healthcare expenditure to enhance health status within the EU. Identifying pivotal determinants and barriers enables policymakers to formulate targeted strategies to mitigate disparities and foster inclusive growth to promote equitable healthcare access and advance overall societal well-being.

Evaluating the Acceptability and Impact of an Online, Lifestyle-Based Mental Well-Being Initiative Targeting School Communities in New York State - Lifting the School Community Project

PURPOSE

To determine the acceptability and impact of an online, lifestyle-based mental well-being initiative in a school-based setting.

APPROACH

A post-program evaluation survey was administered after the intervention.

SETTING

Fifty-seven New York State school districts.

PARTICIPANTS

Participating school districts invited all employees and community members to register for the intervention. A total of 4083 individuals participated, with 1060 (26%) responding to the post-program survey.

INTERVENTION

The 7-week intervention (The Lift Project) incorporated strategies from lifestyle medicine, positive psychology and neuroscience literature. The ten lessons included online, video-based content and related experiential learning exercises.

METHODS

The post-program survey included Likert items that evaluated the participants' perceived program acceptability, mental health enhancement, self-efficacy, and skill acquisition. Inductive thematic qualitative analysis assessed the participants' likes and dislikes concerning the initiative.

RESULTS

A high percentage of respondents indicated that the program improved their well-being (85%), enhanced their well-being-related self-efficacy (92%), and provided them with skills for supporting their long-term mental well-being (82%). Respondents liked the evidence-based, engaging content and design elements and the focus on personal well-being, community connection, and practical applicability. Some respondents desired more social connection, disliked certain design elements, lacked time and experienced technical issues.

CONCLUSION

The initiative was acceptable and impactful, indicating that school districts may serve as an effective network for addressing the mental health epidemic.

Classifying the features of digital mental health interventions to inform the development of a patient decision aid

Digital mental health interventions (DMHIs) are a potential scalable solution to improve access to psychological support and therapies. DMHIs vary in terms of their features such as delivery systems (Websites or Apps) and function (information, monitoring, decision support or therapy) that are sensitive to the needs and preferences of users. A decision aid is warranted to empower people to make an informed preference-based choice of DMHIs. We conducted a review of features of DMHIs to embed within a patient decision aid to support shared decision-making. DMHIs, with evidence of availability in the United Kingdom (UK) at the time of the review, were identified from interactive meetings with a multi-disciplinary steering group, an online survey and interviews with adults with lived experience of using DMHIs in the UK. Eligible DMHIs targeted users age ≥16 years with a mental health condition(s), delivered through a digital system. A previous classification system for DMHIs was extended to eight dimensions (Target population; System; Function; Time; Facilitation; Duration and Intensity; and Research Evidence) to guide data extraction and synthesis of findings. Twenty four DMHIs were included in the review. More than half (n = 13, 54%) targeted people living with low mood, anxiety or depression and were primarily delivered via systems such as Apps or websites (or both). Most DMHIs offered one-way transmission of information (n = 21, 88%). Ten (42%) also had two-way communication (e.g., with a healthcare provider). Eighteen (75%) had a function of therapy, with seven and five DMHIs providing monitoring and decision support functions respectively. Most DMHIs were capable of being self-guided (n = 18,75%). Cost and access were primarily free, with some free via referral from the UK NHS or through corporate subscription for employees (n = 11). Eight (33%) DMHIs had evidence of effectiveness from randomised controlled trials. Six statements were developed to elicit user preferences on features of DMHIs: Target Population; Function; Time and Facilitation; System; Cost and Access; and Research Evidence. Preference elicitation statements have been embedded into a prototype decision aid for DMHIs, which will be subjected to acceptability and usability testing.

Combining internet-delivered cognitive behavioural therapy and attention bias modification for reducing depressive symptoms in firefighters: a randomized controlled trial

BACKGROUND

Firefighters are frequently exposed to traumatic events and stressful environments and are at particularly high risk of depressive symptoms.

AIMS

The present study aimed to examine the impact of a combined internet-delivered cognitive behavioral therapy (iCBT) and attention bias modification (ABM) intervention to reduce depressive symptoms in firefighters.

METHOD

The study was a randomized controlled trial carried out in Kunming, China, and involved the recruitment of 138 active firefighters as participants. The intervention lasted for an 8-week duration, during which participants participated in ABM exercises on alternating days and concurrently underwent eight modules of iCBT courses delivered through a smartphone application. Baseline and post-intervention assessments were conducted to evaluate the effects of the intervention.

RESULTS AND DISCUSSION

Results indicated that the combined iCBT and ABM intervention was significantly effective in reducing symptoms of depression compared with the no intervention control group (U=1644, p<0.001, Wilcoxon r=0.280). No significant change was observed in attention bias post-intervention (U=2460, p=0.737, Wilcoxon r=0.039), while a significant increase was observed in attention-bias variability (U=3172, p<0.001, Wilcoxon r=-0.287). This study provides evidence for the effectiveness of the combined iCBT and ABM intervention in reducing depressive symptoms among firefighters. This study provides conceptual support and preliminary evidence for the effectiveness of the combined iCBT and ABM intervention in reducing depressive symptoms among firefighters.

Non-support from the immediate boss is associated with stress and unsafety at work

Background

Work-related complaints are often caused by stress and increased mental strain. Support from your immediate boss and colleagues is crucial to buffer against the negative health effects of the psychosocial working environment.

Aim

The aim of this study was to investigate if support from the immediate boss and colleagues was associated with biological stress levels, unsafety at work, and other work-related conditions.

Methods

Data derives from a subsample of the SCAPIS study, a major Swedish prospective population-based study. In this subsample, a total of N = 5 058 middle-aged persons (50-64 years) from the general population participated; of these, 68.4% (N = 3 462 individuals) provided hair samples. Questionnaires included socio-demographic and self-reports of occupation, stress, and health status. The demand and control questionnaires were used. A biomarker of long-term stress, hair cortisol concentrations (HCC), was also applied.

Results

In this studied cohort, 9.1 % reported a lack of support from their immediate boss, while 90.9% reported that they did get support at work. Significantly more women (p < 0.001) reported non-support. Those with support or not did not differ in terms of age, education, civil status, smoking, or ethnicity. Those with non-support reported a higher extent (p < 0.001) of lower perceived health. The risk for hypertension and high cholesterol was increased by 28 %, respectively, 13 % being in the non-support group. The main findings were associations between lack of support and feelings of unsafety at work (p < 0.001), higher long-term cortisol levels (p < 0.009), lack of support from colleagues (p < 0.001), and feelings of dejected/sad (p < 0.001) and high work pace (p = 0.03).

Conclusion

Individuals who did not have the necessary support from their immediate boss and colleagues reported they felt more insecure at work and had higher biological long-term stress. In workplace health promotion, an awareness of the link between social support at work and health could be an important component.

ONLINE vs. FACE-TO-FACE group coaching to promote teachers mental health: an exploratory field study in German teachers

Introduction

Online formats provide promising and low-threshold options for mental health coaching. However, research on online mental health interventions compared to traditional face-to-face interventions remains scarce. In the present study, the established prevention tool "Teacher Group-coaching Program" (TGP) was applied in both the original face-to-face setting as well as online. TGP focuses on promoting mental health in teachers by strengthening relational skills using the Balint group technique. This technique roots back to a psychoanalytic approach to explore the emotional aspects of (stress inducing) professional relationships. The current study aimed at comparing the satisfaction with and effectiveness of TGP between both settings.

Method

The sample consisted of 104 teachers who voluntarily chose between face-to-face (n = 51) and online (n = 53) setting. In a pre-posttest design, participants completed questionnaires before and after the intervention. Additionally participant's satisfaction with the program was assessed during and after TGP.

Results

Intervention effects did not differ significantly in terms of mental health, general life satisfaction and emotional distancing between TGP online and face-to-face. In line with previous research, there was a pre-posttest improvement for mental distress and the ability to distance oneself for both groups, which did not differ significantly between face-to-face and online setting. Satisfaction with the program was rated high in both settings, suggesting similar acceptance.

Discussion

Although, the absence of an effect is not the evidence of equality of the groups, the present study highlights the potential of online admissions of mental health interventions as possible alternatives and additions to traditional face-to-face programs, especially when in-person meetings are not feasible. Specifically, it shows evidence that the Balint group technique can also be applied successfully by trained experts in the online setting.

Effectiveness of Digital Mental Health Interventions in the Workplace: Umbrella Review of Systematic Reviews

BACKGROUND

There is potential for digital mental health interventions to provide affordable, efficient, and scalable support to individuals. Digital interventions, including cognitive behavioral therapy, stress management, and mindfulness programs, have shown promise when applied in workplace settings.

OBJECTIVE

The aim of this study is to conduct an umbrella review of systematic reviews in order to critically evaluate, synthesize, and summarize evidence of various digital mental health interventions available within a workplace setting.

METHODS

A systematic search was conducted to identify systematic reviews relating to digital interventions for the workplace, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The review protocol was registered in the Open Science Framework. The following databases were searched: PubMed, Web of Science, MEDLINE, PsycINFO, and Cochrane Library. Data were extracted using a predefined extraction table. To assess the methodological quality of a study, the AMSTAR-2 tool was used to critically appraise systematic reviews of health care interventions.

RESULTS

The literature search resulted in 11,875 records, which was reduced to 14 full-text systematic literature reviews with the use of Covidence to remove duplicates and screen titles and abstracts. The 14 included reviews were published between 2014 and 2023, comprising 9 systematic reviews and 5 systematic reviews and meta-analyses. AMSTAR-2 was used to complete a quality assessment of the reviews, and the results were critically low for 7 literature reviews and low for the other 7 literature reviews. The most common types of digital intervention studied were cognitive behavioral therapy, mindfulness/meditation, and stress management followed by other self-help interventions. Effectiveness of digital interventions was found for many mental health symptoms and conditions in employee populations, such as stress, anxiety, depression, burnout, and psychological well-being. Factors such as type of technology, guidance, recruitment, tailoring, and demographics were found to impact effectiveness.

CONCLUSIONS

This umbrella review aimed to critically evaluate, synthesize, and summarize evidence of various digital mental health interventions available within a workplace setting. Despite the low quality of the reviews, best practice guidelines can be derived from factors that impact the effectiveness of digital interventions in the workplace.

TRIAL REGISTRATION

OSF Registries osf.io/rc6ds; https://doi.org/10.17605/OSF.IO/RC6DS.

A systematic realist synthesis of digital interventions for enhancing mental health at work: contexts, mechanisms, and outcomes

BACKGROUND

Digital interventions (DIs) have emerged as promising tools for promoting mental health in the workplace. However, evidence on if, how, and under what circumstances they affect positive outcomes requires elucidation. This systematic realist review aimed to synthesize current knowledge on contexts, mechanisms, and outcomes of workplace DIs to enhance mental health at work.

METHODS

The review integrates elements of both systematic and realist review methodologies. Forty-four workplace mental health DIs studies were gathered through a systematic electronic search using PsycNet, Scopus, Web of Science, and PubPsych.

RESULTS

Results showed that demographics, previous mental health, and personal skills were the main individual context factors influencing the success of DIs. Key mechanisms were DIs usage, frequency, adherence, and relevance of content triggering positive perceptual shifts. Results showed improvements in psychological resources, wellbeing, and affect. Reduced ill-health symptoms were also evidenced. Five propositions were developed on the contexts and mechanisms under which digital interventions yield positive outcomes for mental health at work.

CONCLUSIONS

This study highlights several areas where future research can expand our understanding of DIs in the workplace by examining interactions between mechanisms and cultural aspects influencing implementation.

Digital Meditation to Target Employee Stress: A Randomized Clinical Trial

Importance

Mindfulness meditation may improve well-being among employees; however, effects of digital meditation programs are poorly understood.

Objective

To evaluate the effects of digital meditation vs a waiting list condition on general and work-specific stress and whether greater engagement in the intervention moderates these effects.

Design, Setting, and Participants

This randomized clinical trial included a volunteer sample of adults (aged ≥18 years) employed at a large academic medical center who reported mild to moderate stress, had regular access to a web-connected device, and were fluent in English. Exclusion criteria included being a regular meditator. Participants were recruited from May 16, 2018, through September 28, 2019, and completed baseline, 8-week, and 4-month measures assessing stress, job strain, burnout, work engagement, mindfulness, depression, and anxiety. Data were analyzed from March 2023 to October 2024.

Intervention

Participants were randomized 1:1 to a digital meditation program or the waiting list control condition. Participants in the intervention group were instructed to complete 10 minutes of meditation per day for 8 weeks. The control group was instructed to continue their normal activities and not add any meditation during the study period.

Main Outcomes and Measures

The primary outcome measure was change in Perceived Stress Scale (PSS) score at 8 weeks. Secondary outcome measures included changes in job strain, measured as work effort-reward imbalance.

Results

A total of 1458 participants (mean [SD] age, 35.54 [10.30] years; 1178 [80.80%] female) were included. Those randomized to meditation (n = 728) vs waiting list (n = 730) showed improvements in PSS (Cohen d, 0.85; 95% CI, 0.73-0.96) and in all secondary outcome measures (eg, job strain: Cohen d, 0.34; 95% CI, 0.23-0.46) at 8 weeks. These improvements were maintained at 4 months after randomization (PSS: Cohen d, 0.71; 95% CI, 0.59-0.84; job strain: Cohen d, 0.37; 95% CI, 0.25-0.50). Those using the app from 5 to 9.9 min/d vs less than 5 min/d showed greater reduction in stress (mean PSS score difference, -6.58; 95% CI, -7.44 to -5.73).

Conclusions and Relevance

The findings suggest that a brief, digital mindfulness-based program is an easily accessible and scalable method for reducing perceptions of stress. Future work should seek to clarify mechanisms by which such interventions contribute to improvements in work-specific well-being.

Trial Registration

ClinicalTrials.gov Identifier: NCT03527303.

Community-based health programme for nurses and midwives: A mixed methods evaluation

AIM

To evaluate a community-based psychological health and well-being programme for nurses and midwives.

DESIGN

Mixed methods programme evaluation.

METHODS

Four studies were included: observational descriptive study (cross-sectional survey) of the health, well-being and experiences of previous programme participants (Study 1); observational exploratory prospective cohort study (longitudinal survey) of health, well-being and experiences of participants who engaged in the programme from 2020 to 2023 (Study 2); qualitative descriptive study (interviews) of experiences and perceptions of nurses and midwives who have engaged with the programme as participants or clinicians (Study 3); observational descriptive study (cross-sectional survey) of experiences and perceptions of programme stakeholders (Study 4). Surveys included validated measures. Data were collected online. Descriptive, repeated measures and thematic analyses were conducted.

RESULTS

One-hundred and fifteen participants completed Study 1: 20% (n = 23) reported stress in the severe-to-extremely severe category; 22% (n = 25) reported psychological distress in the moderate-to-severe category. Thirty-one programme participants were followed in Study 2: the effect of the programme on participant well-being over time was not significant. Sixteen programme participants and eight programme clinicians were interviewed (Study 3). Experiences of nurses and midwives engaging with the programme were highly positive and strong attributes of the programme included (1) shared professional experience of clinicians and participants which supported a common language and facilitated understanding, and (2) effective programme leadership, and autonomy and flexibility in the clinicians' role which enabled and supported a positive working experience. Thirty-nine broader stakeholders participated in a cross-sectional survey (Study 4). All stakeholders reported high satisfaction with the programme. Participants considered the programme being 'by nurses and midwives, for nurses and midwives' critical to the programme's success and value.

CONCLUSIONS

The community-based psychological health and well-being programme developed, led and delivered by nurses and midwives, for nurses and midwives, was a highly valued resource.

IMPACT

Levels of stress and burnout in the health workforce are high. A community-based psychological health and well-being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives. A programme delivered by nurses and midwives, for nurses and midwives, was considered critical to programme success. Programme leadership, and autonomy and flexibility in the programme clinicians' roles, facilitated and supported a positive working experience for programme clinicians.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Quality and safety in patient care is directly impacted by the well-being of nurse and midwives. A community-based psychological health and well-being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives.

REPORTING METHOD

Survey findings were reported according to STROBE (von Elm et al. in Lancet, 370:1453-1457, 2007) and qualitative findings according to COREQ (Tong et al. in International Journal for Quality in Health Care, 19(6):349-357, 2007).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A comparison of firefighter mental health education programs: A descriptive thematic analysis of firefighter experiences

BACKGROUND

In response to the inherent critical incident exposures experienced by firefighters, various mental health education programs have been developed. The purpose of this study was to explore the perceptions of firefighters who took such programs to understand differences/similarities across these programs.

METHODS

We recruited 14 participants, who had taken or delivered two or more programs for firefighters (Resilient Minds (RM), Road to Mental Readiness (R2MR), and Before Operational Stress (BOS)). Participants participated in semi-structured interviews, which explored information that they learned, recalled, used, and their preferences. Data was analysed using thematic analysis.

RESULTS

Participants believed that all programs had some shared teaching methods, goals, skills, and topics; however, each program had key focuses/distinctive features. RM was said to be largely group participation and focused on assisting yourself, peers, and citizens. R2MR and BOS was said to be largely lecture style with a focus on the self. 70 % of participants who took RM (n = 7) and one other course preferred RM due to the specificity of training to firefighters, more active teaching methods, and focus on practical skill development. Others (43 %) had no program preference. Participants suggest that a tiered approach to mental health education would benefit firefighters.

CONCLUSIONS

All programs were seen as helpful. Despite some congruency in goals and content, most firefighters preferred RM because the content was fire-specific, and the pedagogical approach was seen as more active and engaging. Program characteristics are important to facilitate appropriate program selection, as such, programs should be explicit about these aspects.

Differential attrition and engagement in randomized controlled trials of occupational mental health interventions in person and online: A systematic review and meta-analysis

OBJECTIVE

This study systematically reviewed and meta-analyzed the differential attrition and utilization of occupational mental health interventions, specifically examining delivery methods (internet-based versus in-person).

METHODS

The research, with papers spanning 2010-2024, involved filtering criteria and comprehensive searches across PubMed, Scopus, and Web of Science Core (PROSPERO registration n. CRD42022322394). Of 28 683 titles, 84 records were included in the systematic review, with 75 in meta-analyses. Risk of bias was assessed through the revised Cochrane risk of bias tool for randomized control trials and funnel plots. Differential attrition across studies was meta-analysed through a random-effects model with limited maximum-likelihood estimation for the degree of heterogeneity.

RESULTS

Findings reveal higher mean differential attrition in the intervention group, indicating a potential challenge in maintaining participant engagement. The attrition rates were not significantly influenced by the mode of intervention delivery (internet versus in-person). Compensation for participation and year of publication could potentially influence differential attrition from baseline to follow-up measurements.

CONCLUSIONS

These results suggest a need for cautious consideration of attrition in occupational mental health intervention study designs and emphasize the importance of adapting statistical analyses to mitigate potential bias arising from differential attrition.

Discriminant analysis of occupational performance characteristics in patients with major depressive disorders and healthy individuals

Aim

Assessing symptoms and daily functioning in patients with major depressive disorder (MDD) can be challenging, as their limited self-monitoring abilities may result in behavior observed during structured interviews not accurately reflecting their daily lives. This study aimed to determine if specific occupational behaviors could distinguish individuals with MDD from healthy individuals.

Methods

Baseline data were collected from medical records and activity programs. Three occupational therapists conducted content analysis to assess occupational performance characteristics. Chi-squared tests compared the prevalence of these characteristics between patients with MDD and healthy controls. Multivariable logistic regression controlled for potential confounders, with independent variables selected based on clinical relevance and sample size (p < 0.01). Discriminant analysis was used to enhance group differentiation, assessing prediction rates using area under the curve (AUC) values.

Results

A total of 69 occupational performance characteristics were identified, with 12 showing significant differences between 27 patients with MDD and 43 healthy controls. Key discriminators included "Ask questions and consult" (p < 0.001, odds ratio [OR] = 0.051, 95% confidence interval [CI] = 0.009-0.283), "Concentrate on work" (p = 0.003, OR = 0.078, 95% CI = 0.015-0.416), "Choose simple work" (p = 0.004, OR = 17.803, 95% CI = 2.446-129.597), and "Punctual" (p = 0.017, OR = 0.030, 95% CI = 0.002-0.530). Discriminant analysis using these variables yielded a Wilks' λ of 0.493 (p < 0.001), achieving an 88.6% accuracy rate. The receiver operating characteristic curve's AUC value was 0.911 (sensitivity = 95.3%, specificity = 77.8%).

Conclusion

This study highlights the importance of occupational performance characteristics in tailoring treatment strategies for MDD, providing insights beyond traditional assessment methods.

Temporary Telemedicine Policy and Chronic Disease Management in South Korea: Retrospective Analysis Using National Claims Data

BACKGROUND

Since its introduction, telemedicine for patients with chronic diseases has been studied in various clinical settings. However, there is limited evidence of the effectiveness and medical safety of the nationwide adoption of telemedicine.

OBJECTIVE

This study aimed to analyze the effects of telemedicine on chronic diseases during the COVID-19 pandemic under a temporary telemedicine policy in South Korea using national claims data.

METHODS

Health insurance claims data were extracted over 2 years: 1 year before (from February 24, 2019, to February 23, 2020) and 1 year after the policy was implemented (from February 24, 2020, to February 23, 2021). We included all patients who used telemedicine at least once in the first year after the policy was implemented and compared them with a control group of patients who never used telemedicine. The comparison focused on health care use; the medication possession ratio (MPR); and admission rates to general wards (GWs), emergency departments (EDs), and intensive care units (ICUs) using difference-in-differences analysis. A total of 4 chronic diseases were targeted: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and common mental disorders.

RESULTS

A total of 1,773,454 patients with hypertension; 795,869 patients with DM; 37,460 patients with COPD; and 167,084 patients with common mental disorders were analyzed in this study. Patients diagnosed with hypertension or DM showed increased MPRs without an increase in GW, ED, or ICU admission rates during the policy year. Moreover, patients in the DM group who did not use telemedicine had higher rates of ED, GW, and ICU admissions, and patients in the hypertension group had higher rates of GW or ICU admissions after 1 year of policy implementation. This trend was not evident in COPD and common mental disorders.

CONCLUSIONS

The temporary telemedicine policy was effective in increasing medication adherence and reducing admission rates for patients with hypertension and DM; however, the efficacy of the policy was limited for patients with COPD and common mental disorders. Future studies are required to demonstrate the long-term effects of telemedicine policies with various outcome measures reflecting disease characteristics.

Mental health interventions affecting university faculty: a systematic review and meta-analysis

BACKGROUND

While there is growing evidence highlighting the prevalence of mental health concerns among university faculty, few studies have examined mental health interventions in this population. The objective of this systematic review and meta-analysis was to collect and critically appraise the available evidence about the effectiveness of interventions designed to improve the mental health of faculty.

METHODS

A systematic search was conducted by searching PubMed, EMBASE, Scopus, Web of Science, and CINAHL to identify relevant studies published in English language from January 1st, 2000 until October 1st, 2023. The search focused on studies done on academic faculty to describe interventions or support programs aimed at improving mental health outcomes, with comparison of mental health data before and after the intervention and an improvement in mental health as study outcome. A random effect meta-analysis method was used to estimate the effectiveness of interventions on faculty mental health.

RESULTS

Ten publications with 891 participants from 2,217 retrieved records were included. The random effect model showed substantial heterogeneity (I2 = 84.8%, 95% CI: 73.8 - 91.2%, p < 0.001). The pooled SMD was - 1.41 (95% CI: -2.81-0.004) showing a large effect, and it significantly favors the use of intervention for reducing mental health issues among faculty members. The effect size estimates for all included studies ranged from small to large, showing the positive effect of intervention on faculty mental health. Multimodal inference analysis showed that, of the many studied factors for faculty mental health, the region was the most important predictor of intervention effectiveness. However, when the significance of quantitative moderators was tested using meta-regression, age (p = 0.9491) and duration of intervention (p = 0.1284) were not statistically significant.

CONCLUSION

Interventions aimed at enhancing the mental health of university faculty were overall significant; however, individual studies showed heterogeneous results. Making efforts to enhance the mental health of faculty is crucial and has been proven effective; nevertheless, the existing evidence necessitates further research in this area. For interventions to be effective, it is imperative to tailor them to the specific environment and to the unique characteristics of faculty members.

PROSPERO REGISTRATION NUMBER

CRD42023490388.

Factors facilitating and hindering the implementation of digital sleep coaching for bus drivers

Improving fatigue management is critical to the occupational safety of professional drivers. We aimed to identify the factors that facilitated or hindered the implementation of digital sleep coaching in bus companies and to explore bus drivers' experiences with it. Two bus companies implemented coaching for bus drivers. Using a mixed methods design, we collected data through two workshops (n = 30 and n = 27) attended by key personnel from the organisations and through questionnaires to the drivers (n = 30). Implementation was facilitated by, for example, the flexible participation and multichannel information of coaching, and hindered by restrictions on social support due to the COVID-19 pandemic, and lack of interest and inspiring examples. On average, the drivers rated the appropriateness and the feasibility of coaching as good. However, further development could lead to wider dissemination. It would also be important to involve the key people in the organisations and stakeholders more in supporting the implementation.

The effect of an integrated workplace health promotion program on health behaviors targeted after 12 months: Results of a cluster randomized controlled trial

INTRODUCTION

An integrated workplace health promotion program (WHPP) targeting multiple health behaviors by implementing activities at the individual and organizational level is potentially effective. The aim of this study was to evaluate the effect of implemented activities on targeted health behaviors.

METHODS

Data from four organizations in a cluster randomized controlled trial, including 173 employees, were used. Linear multilevel analyses or generalized estimating equations were conducted to assess within- and between-condition differences for physical activity (PA) and nutrition.

RESULTS

No between-condition differences were apparent for both health behaviors. Within the PA intervention condition, moderate PA increased and light PA decreased. Within the control condition the odds to consume more sugary drinks was lower.

CONCLUSION

Implemented activities did not affect the targeted health behaviors, although moderate PA increased within the PA intervention condition. Small sample sizes and implementation of minimal, irregular activities may underly the absence of effect. Future research should address this.

The implementation of an integrated workplace health promotion program in Dutch organizations - A mixed methods process evaluation

OBJECTIVE

To gain insight into 1) the degree of implementation of an integrated workplace health promotion program (WHPP) 2) the perceptions of employers and employees regarding an integrated WHPP and 3) the contextual factors that hindered or enhanced implementation.

METHODS

Data were collected by means of questionnaires, interviews among 19 employees, supervisors and HR-professionals, monitoring charts and observations at 6-10 months after the start of the implementation of the integrated WHPP. To evaluate the implementation process, ten process indicators from the evaluation frameworks of Nielsen & Randall and Wierenga were assessed. Descriptive analyses were performed for the process indicators as measured by questionnaires, monitoring charts and observations. Interviews with employers and employees were recorded, transcribed and then coded by two researchers independently by means of thematic coding.

RESULTS

The results cover the following topics: implemented activities, the working group, engagement of employees, the role of management and policy and organizational preconditions. Although the criteria of the WHPP were not completely met, various activities were implemented in all participating organizations. Working groups consisting of Human Resources professionals, supervisors and employees, who selected and implemented activities, were composed within each organization. 22% of the employees did not feel involved in the implementation process. The absence of organizational policies regarding WHP hampered implementation. Organizations had the intention to continue with the integrated WHPP, which requires sufficient time and budget.

CONCLUSIONS

The implementation of the integrated WHPP appeared to be challenging and complex. Working groups indicated that they made the first important steps in integrating WHP in their organization and had the intention to continue with the implementation. However, to increase the impact, employers and employees should have the opportunity to implement and participate in WHP. Hence, organizational policies regarding WHP and active support of higher management are expected to be essential.

Facilitators of and Barriers to Teachers' Engagement With Consumer Technologies for Stress Management: Qualitative Study

BACKGROUND

Consumer technology is increasingly being adopted to support personal stress management, including by teachers. Multidisciplinary research has contributed some knowledge of design and features that can help detect and manage workplace stress. However, there is less understanding of what facilitates engagement with ubiquitous "off the shelf" technologies, particularly in a specific occupational setting. An understanding of features that facilitate or inhibit technology use, and the influences of contexts on the manner of interaction, could improve teachers' stress-management opportunities.

OBJECTIVE

The aim of the study was to investigate the interaction features that facilitated or inhibited engagement with 4 consumer technologies chosen by teachers for stress management, as well as the influence of the educational contexts on their engagement. We also examined how use of well-being technology could be better supported in the school.

METHODS

The choice of consumer technologies was categorized in a taxonomy for English secondary school teachers according to stress-management strategies and digital features. Due to the COVID-19 pandemic, we adapted the study so that working from home in the summer could be contrasted with being back in school. Thus, a longitudinal study intended for 6 weeks in the summer term (in 2020) was extended into the autumn term, lasting up to 27 weeks. Teachers chose to use either a Withings smartwatch or Wysa, Daylio, or Teacher Tapp apps. Two semistructured interviews and web-based surveys were conducted with 8 teachers in England in the summer term, and 6 (75%) of them took part in a third interview in the autumn term. Interviews were analyzed using reflexive thematic analysis informed by interpretive phenomenological analysis.

RESULTS

Technology elements and characteristics such as passive data collation, brevity of interaction, discreet appearance, reminders, and data visualization were described by teachers as facilitators. Lack of instructions and information on features, connectivity, extended interaction requirements, and nondifferentiation of activity and exercise data were described as barriers. Mesocontextual barriers to engagement were also reported, particularly when teachers were back on school premises, including temporal constraints, social stigma, and lack of private space to de-stress. Teachers had ideas for feature improvements and how educational leadership normalizing teachers' stress management with consumer technologies could benefit the school culture.

CONCLUSIONS

Having preselected their stress-management strategies, teachers were able to harness design features to support themselves over an extended period. There could be an important role for digital interventions as part of teachers' stress management, which the school leadership would need to leverage to maximize their potential. The findings add to the holistic understanding of situated self-care and should inform developers' considerations for occupational digital stress support.

Effectiveness of an online text-based stress management program for employees who work in micro- and small-sized enterprises: A randomized controlled trial

Background

Internet psychoeducational interventions improve employees' mental health. However, implementing them for employees in micro- and small-sized enterprises (MSEs) is challenging.

Objectives

This randomized controlled trial examined the effectiveness of a fully automated text-based stress management program, "WellBe-LINE," in improving mental health and job-related outcomes for employees in workplaces with fewer than 50 employees.

Methods

The program was developed based on stakeholder interviews and surveys of 1000 employees at MSEs. Adult full-time employees at an enterprise with fewer than 50 employees were recruited from registered members of a web survey company in Japan. Participants were randomly allocated to the intervention or control group (1:1). Participants in the intervention group were invited to register for the program using the LINE app. Psychological distress measured by Kessler 6 (K6) was a primary outcome, with self-administrated questionnaires at baseline, 2-month (post), and 6-month follow-ups. A mixed model for repeated measures conditional growth model analysis was conducted using a group ∗ time interaction as an intervention effect. Implementation outcomes were measured through implementation outcome scales for digital mental health (iOSDMH).

Results

1021 employees were included in this study. No significant effects were shown in any outcome. The reported implementation outcomes were positively evaluated, with 80 % acceptability, 86 % appropriateness, and feasibility (ease of understanding the contents [88 %], frequency [86 %], and length of content [86 %]).

Conclusions

A simple text-message program for employees at MESs was acceptable, appropriate, and feasible; however, it did not result in improved mental health or job-related outcomes.

Trial registration

UMIN clinical trial registration: UMIN000050624 (registration date: March 18, 2023).

Effectiveness of a Smartphone-Based Stress Management Program for Depression in Hospital Nurses During COVID-19 in Vietnam and Thailand: 2-Arm Parallel-Group Randomized Controlled Trial

BACKGROUND

During the COVID-19 pandemic, health care professionals experienced high levels of depression. However, extant research has not highlighted effective internet-based psychological interventions to improve the mental health in this population during the pandemic. It remains unclear whether self-guided, internet-based cognitive behavioral therapy (iCBT) programs are effective in improving the mental health of health care workers during the COVID-19 pandemic.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of a smartphone-based iCBT stress management program for reducing the depression experienced by nurses in Vietnam and Thailand.

METHODS

From March to April 2022, a 2-arm, parallel-group randomized controlled trial was implemented. One arm offered a 7-week self-guided iCBT program, and the other offered treatment as usual as a control arm. Full-time nurses were recruited from 6 hospitals: 2 hospitals in Vietnam and 4 hospitals in Thailand. The primary outcome of this program was the severity of depression measured by the Depression Anxiety Stress Scale-21 items. Follow-up surveys were conducted to measure the change in depression severity at 3 months (July-August 2022) and at 6 months (October-November 2022) after baseline. Mixed modeling for repeated measures was used to test the effects of the intervention compared with the control for the follow-up.

RESULTS

A total of 1203 nurses were included in this study: 602 in the intervention group and 601 in the control group. The follow-up rate at 3 and 6 months ranged from 85.7% (515/601) to 87.5% (527/602). The completion rate for the program was 68.1% (410/602). The group difference in depression was significant at the 3-month follow-up (coefficient=-0.92, 95% CI -1.66 to -0.18; P=.02) and nonsignificant at the 6-month follow-up (coefficient=-0.33, 95% CI -1.11 to 0.45; P=.41). The estimated effect sizes were -0.15 and -0.06 at the 3- and 6-month follow-ups, respectively.

CONCLUSIONS

Our study shows that the smartphone-based iCBT program was effective in reducing depression at the 3-month follow-up among hospital nurses in Vietnam and Thailand during the COVID-19 pandemic. However, the effect size was small, and therefore, these results may not be clinically meaningful.

TRIAL REGISTRATION

UMIN Clinical Trials Registry UMIN000044145; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000050128.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.20944/preprints202303.0450.v1.

Unmet Mental Health Needs Among California Workers Since the Start of the COVID-19 Pandemic

OBJECTIVE

We sought to identify worker groups with high prevalence of unmet mental health needs to inform employer benefits programs and outreach to increase access to care.

METHODS

We conducted a repeated cross-sectional study to understand unmet mental health needs among workers since the start of the COVID-19 pandemic using the California Health Interview Survey data from 2013 to 2021.

RESULTS

In 2021, 23.4% (confidence interval: 22.4 to 24.4) reported unmet mental health needs, an absolute increase of 3.9% from 2019. Relative increases were highest among workers in the information industries (prevalence ratio: 1.89, confidence interval: 1.4 to 2.5) and older workers (prevalence ratio: 1.27, CI: 0.9 to 1.8). Increases in needing help were not met with comparable increases in seeking care.

CONCLUSIONS

Unmet mental health needs increased for California workers during the pandemic. Employers should dedicate resources and implement strategies to increase access to care and promote worker well-being.

Mental Health Stigma in the Workplace and its Association with Possible Actions of Managers to Prevent Sickness Absence of Employees with Mental Health Problems in the Swedish Private Sector: a Video Vignette Study

PURPOSE

Mental health problems (MHPs) are subjected to workplace stigma and can deteriorate into common mental disorders (CMDs) and sickness absence (SA). Research has shown that personal stigmatizing attitudes limit managers' efforts towards employees with MHPs, but knowledge is lacking regarding stigma in social contexts (contextual stigma) and different types of possible preventive actions. This study investigates personal stigmatizing attitudes and three contextual stigma layers (employee, collegial, organizational) and different types of possible actions to prevent SA of employees with MHPs.

METHOD

Survey data of 2769 Swedish managers working in the private sector were analysed. Personal stigmatizing attitudes were measured with the managerial stigma towards employee depression scale and supplemented with four additional items capturing contextual stigma. Managers watched video vignettes and assessed which preventive actions (n  = 20) were possible to use in their organization. A sum score was calculated reflecting the 'number of actions'. Principal component analysis revealed three action types: adapt tasks and setting, involve experts, and social support. A score reflecting the 'possibilities to implement actions' was calculated for each type. Multiple linear regression analyses were conducted with the four stigma layers as independent variables for each of the three action variables.

RESULTS

Personal stigmatizing attitudes and contextual stigma were significantly associated with both 'number of actions' and 'possibilities for implementing actions' relating to all action types. Patterns of associations with contextual stigma were significant but varied between the different action types.

CONCLUSION

This study substantiated the role of personal stigmatizing attitudes and contextual stigma in relation to possible actions of managers to prevent SA of employees with MHPs. The results emphasize the role of contextual stigma. Implications for practice and research are discussed.

Web-based occupational stress prevention in German micro- and small-sized enterprises - process evaluation results of an implementation study

BACKGROUND

Structural and behavioral interventions to manage work-related stress are effective in employees. Nonetheless, they have been implemented insufficiently, particularly in micro- and small-sized enterprises (MSE). Main barriers include a lack of knowledge and limited resources, which could potentially be overcome with simplified web-based alternatives for occupational stress prevention. However, there is a lack of implementation research about web-based prevention in realistic settings of MSE.

OBJECTIVE

The aim of this study is to evaluate the implementation process and success of an integrated web-based platform for occupational stress prevention ("System P") and to identify potential barriers for its uptake and use in MSE in Germany.

METHODS

This study with a mixed-methods approach investigates eight process-related outcomes in a quantitative part I (adoption, reach, penetration, fidelity/dose, costs, acceptability) and a qualitative part II (acceptability, appropriateness and feasibility). Part I has a pre-post design with two measurements (6 months apart) with 98 individual participants and part II consists of 12 semi-structured interviews with managers and intercorporate stakeholders.

RESULTS

Part I revealed shortcomings in the implementation process. Adoption/Reach: Despite extensive marketing efforts, less than 1% of the contacted MSE responded to the offer of System P. A total of 40 MSE registered, 24 of which, characterized by good psychosocial safety climate, adopted System P. Penetration: Within these 24 MSE, 15% of the employees used the system. Fidelity/Dose: 11 MSE started a psychosocial risk-assessment (PRA), and no MSE finished it. The stress-management training (SMT) was started by 25 users and completed by 8.

COSTS

The use of System P was free of charge, but the time required to engage with was an indirect cost. Part II added insights on the perception of the web-based intervention: Acceptance of System P by users and stakeholders was good and it was assessed as appropriate for MSE. Results for feasibility were mixed.

CONCLUSIONS

Although System P was generally perceived as useful and appropriate, only a small number of contacted MSE implemented it as intended. Prior experience and sensitivity for occupational (stress) prevention were mentioned as key facilitators, while (perceived) indirect costs were a key barrier. Enabling MSE to independently manage stress prevention online did not result in successful implementation. Increasing external support could be a solution. ⁺ FULL PROJECT NAME: "PragmatiKK - Pragmatische Lösungen für die Implementation von Maßnahmen zur Stressprävention in Kleinst- und Kleinbetrieben" (= Pragmatic solutions for the implementation of stress prevention interventions in micro and small-sized enterprises).

TRIAL REGISTRATION

German Register of Clinical Studies (DRKS) DRKS00026154, date of registration 2021-09-16.

START NOW WebApp-promoting emotion regulation and resilience in residential youth care and correctional institutions: study protocol for a cluster randomized controlled trial

BACKGROUND

Adolescents and young adults in residential care and correctional institutions face various challenges, leading to negative life outcomes. Implementation barriers within these institutions, such as limited financial and spatial resources, pose significant hurdles to providing necessary support. Web-based approaches address these challenges by offering cost-effective, accessible solutions. This study aims to assess the efficacy of a newly developed web-based version of the existing evidence-based START NOW skills training in fostering emotion regulation and resilience among institutionalized adolescents and young adults. We present the study protocol (Version 5, August 2023) of the trial titled "Implementation of an e-version of the skills training START NOW for promoting emotion regulation and resilience in residential youth care and correctional institutions".

METHODS

The study is a monocentric, prospective, confirmatory randomized controlled trial with 150 institutionalized adolescents and young adults with a need to improve resilience (predefined cut-offs). Participating institutions will be randomized to one of three conditions: (i) 9-week web-based group training guided by a facilitator, (ii) 9-week web-based self-help training, (iii) and treatment as usual. The primary endpoint is the change in psychological flexibility, assessed by the Avoidance and Fusion Questionnaire for Youth score, from baseline to follow-up 12 weeks post skills training. Secondary objectives encompass assessing pre-post changes in psychological flexibility and other psychological health-related outcome measures in participating adolescents, young adults, and caretakers from baseline, to post training, and to 12- and 24-week follow-ups.

DISCUSSION

This study evaluates the efficacy of START NOW as web-based training for institutionalized adolescents and young adults, providing valuable insights into web-based interventions and aiming to optimize support levels. TRIAL REGISTRATION {2A AND 2B}: ClinicalTrials.gov NCT05313581. Registered on 6 April 2022.

Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial

BACKGROUND

Reproductive health literacy and menstrual health awareness play a crucial role in ensuring the health and well-being of women and people who menstruate. Further, awareness of one's own menstrual cycle patterns and associated symptoms can help individuals identify and manage conditions of the menstrual cycle such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Digital health products, and specifically menstrual health apps, have the potential to effect positive change due to their scalability and ease of access.

OBJECTIVE

The primary aim of this study was to measure the efficacy of a menstrual and reproductive health app, Flo, in improving health literacy and health and well-being outcomes in menstruating individuals with and without PMS and PMDD. Further, we explored the possibility that the use of the Flo app could positively influence feelings around reproductive health management and communication about health, menstrual cycle stigma, unplanned pregnancies, quality of life, work productivity, absenteeism, and body image.

METHODS

We conducted 2 pilot, 3-month, unblinded, 2-armed, remote randomized controlled trials on the effects of using the Flo app in a sample of US-based (1) individuals who track their cycles (n=321) or (2) individuals who track their cycles and are affected by PMS or PMDD (n=117).

RESULTS

The findings revealed significant improvements at the end of the study period compared to baseline for our primary outcomes of health literacy (cycle tracking: D̄=1.11; t311=5.73, P<.001; PMS or PMDD: D̄=1.20; t115=3.76, P<.001) and menstrual health awareness (D̄=3.97; t311=7.71, P<.001), health and well-being (D̄=3.44; t311=5.94, P<.001), and PMS or PMDD symptoms burden (D̄=-7.08; t115=-5.44, P<.001). Improvements were also observed for our secondary outcomes of feelings of control and management over health (D̄=1.01; t311=5.08, P<.001), communication about health (D̄=0.93; t311=2.41, P=.002), menstrual cycle stigma (D̄=-0.61; t311=-2.73, P=.007), and fear of unplanned pregnancies (D̄=-0.22; t311=-2.11, P=.04) for those who track their cycles, as well as absenteeism from work and education due to PMS or PMDD (D̄=-1.67; t144=-2.49, P=.01).

CONCLUSIONS

These pilot randomized controlled trials demonstrate that the use of the Flo app improves menstrual health literacy and awareness, general health and well-being, and PMS or PMDD symptom burden. Considering the widespread use and affordability of the Flo app, these findings show promise for filling important gaps in current health care provisioning such as improving menstrual knowledge and health.

TRIAL REGISTRATION

OSF Registries osf.io/pcgw7; https://osf.io/pcgw7 ; OSF Registries osf.io/ry8vq; https://osf.io/ry8vq.

A Web-Based and Mobile Intervention Program Using a Spaced Education Approach for Workplace Mental Health Literacy: Cluster Randomized Controlled Trial

Background

Workplace mental health is an important global health concern.

objectives

This unblinded, phase-III, wait-listed cluster randomized controlled trial aimed to examine the effectiveness of a mobile health (mHealth) psychoeducation program using a spaced education approach on mental health literacy (MHL) in the workplace. The main interest of this paper was the immediate and 3-month medium-term effect of the program on the MHL of workers. The purposely built mHealth platform was also evaluated as a health-related app.

Methods

The mHealth platform was designed using the principle of spaced education as a psychoeducation intervention program, with various modules of web-based and mobile materials presented to the participant in a progressive manner. Short quizzes at the end of each module ensured adequate learning, and successful completion qualified the learner to progress to the next level. The trial recruited 456 employees of specific industries with high levels of work-related stress. Participants who were nested in different offices or units were allocated into the intervention and wait-listed control groups using a block randomization process, with the office or unit as the cluster. A separate sample of 70 individual raters were used for the evaluation of the mHealth platform. The Australian National MHL and Stigma Survey and the Mobile Apps Rating Scale were completed through a web-based self-reported survey to assess MHL and evaluate the app. The trial and follow-up data were analyzed by a generalized linear latent and mixed model with adjustments for the clustering effect of work sites and repeated measures.

Results

Of the 456 participants in the trial, 236 (51.8%) responded to the follow-up survey. Most MHL outcomes obtained significant results immediately after the intervention and across time. After adjusting for the clustering effect, the postintervention weighted mean scores were significantly higher in the intervention group than the control group for correct recognition of a mental health problem, help seeking, and stigmatization by 0.2 (SE 0.1; P=.003), 0.9 (SE 0.2; P<.001), and 1.8 (SE 0.4; P<.001), respectively. After adjusting for the clustering effect, significant differences across time were found in help-seeking intention (P=.01), stigmatization (P<.001), and social distancing (P<.001). The evaluation of the mHealth program resulted in average scores of the 4 major domains ranging from 3.8 to 4.2, with engagement having the lowest score.

Conclusions

The mHealth psychoeducation intervention program using this platform had immediate and 3-month medium-term effects of retaining and improving MHL. The platform was evaluated to have satisfactory performance in terms of functionality, aesthetics, information content, and utility in enhancing MHL. It is anticipated that ongoing development in digital health will provide great benefits in improving the mental health of the global population.

A population health approach to workplace mental health: rationale, implementation and engagement

Objectives

To describe a population health-based program to support employee and dependent mental health and learn from engagement trends.

Methods

Retrospective analysis of a program utilizing an assessment of mental health risk. For scoring "at risk," a Care Concierge is offered to connect users with resources.

Results

Participation was offered to 56,442 employees and dependents. Eight thousand seven hundred thirty-one completed the assessment (15%). Of those, 4,644 (53%) scored moderate or higher. A total of 418 (9%) engaged the Care Concierge. Factors that negatively influenced the decision to engage care included bodily pain, financial concerns. Positive influences were younger age, high stress, anxiety, PTSD and low social support.

Conclusion

Proactive assessment plus access to a Care Concierge facilitates mental healthcare utilization. Several factors influence likelihood to engage in care. A better understanding of these factors may allow for more targeted outreach and improved engagement.

The use of positive deviance approach to improve health service delivery and quality of care: a scoping review

BACKGROUND

Quality has been a persistent challenge in the healthcare system, particularly in resource-limited settings. As a result, the utilization of innovative approaches is required to help countries in their efforts to enhance the quality of healthcare. The positive deviance (PD) approach is an innovative approach that can be utilized to improve healthcare quality. The approach assumes that solutions to problems are already available within the community and identifying and sharing those solutions can help others to resolve existing issues. Therefore, this scoping review aimed to synthesize the evidence regarding the use of the PD approach in healthcare system service delivery and quality improvement programs.

METHODS

Articles were retrieved from six international databases. The last date for article search was June 02, 2023, and no date restriction was applied. All articles were assessed for inclusion through a title and/or abstract read. Then, articles that passed the title and abstract review were screened by reading their full texts. In case of duplication, only the full-text published articles were retained. A descriptive mapping and evidence synthesis was done to present data with the guide of the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist and the results are presented in text, table, and figure formats.

RESULTS

A total of 125 articles were included in this scoping review. More than half, 66 (52.8%), of the articles were from the United States, 11(8.8%) from multinational studies, 10 (8%) from Canada, 8 (6.4%) from the United Kingdom and the remaining, 30 (24%) are from other nations around the world. The scoping review indicates that several types of study designs can be applied in utilizing the PD approach for healthcare service and quality improvement programs. However, although validated performance measures are utilized to identify positive deviants (PDs) in many of the articles, some of the selection criteria utilized by authors lack clarity and are subject to potential bias. In addition, several limitations have been mentioned in the articles including issues in operationalizing PD, focus on leaders and senior managers and limited staff involvement, bias, lack of comparison, limited setting, and issues in generalizability/transferability of results from prospects perspective. Nevertheless, the limitations identified are potentially manageable and can be contextually resolved depending on the nature of the study. Furthermore, PD has been successfully employed in healthcare service and quality improvement programs including in increasing surgical care quality, hand hygiene practice, and reducing healthcare-associated infections.

CONCLUSION

The scoping review findings have indicated that healthcare systems have been able to enhance quality, reduce errors, and improve patient outcomes by identifying lessons from those who exhibit exceptional practices and implementing successful strategies in their practice. All the outcomes of PD-based research, however, are dependent on the first step of identifying true PDs. Hence, it is critical that PDs are identified using objective and validated measures of performance as failure to identify true PDs can subsequently lead to failure in identifying best practices for learning and dissemination to other contextually similar settings.

Implementation of an internet-based stress management program in micro- and small-sized enterprises: a study protocol for a pre-post feasibility study of the effectiveness-implementation hybrid type 2 trial

BACKGROUND

Although internet-based stress management programs are proven effective in improving mental health among workers, micro- and small-sized enterprises (MSEs), lacking in occupational healthcare services, face challenges implementing them. To address this gap, this study will develop the program with stakeholders at MSEs to aim for real-world implementation.

OBJECTIVES

This paper describes a study protocol for a pre-post feasibility study of an effectiveness-implementation hybrid type 2 trial of text-based internet-based programs ("WellBe-LINE") in MSEs with less than 50 employees. This feasibility study primarily aims to evaluate trial methods for future effectiveness-implementation hybrid type 2 trials.

METHODS

For this study protocol, an internet- and text-based self-care intervention program using the LINE app (a popular message tool in Japan) will be prepared according to evidence-based psychoeducational topics. Based on our online survey findings, personalized algorithms will be implemented according to employees' gender, age, and psychological distress levels. A personalized program using a popular pre-existing text app is expected to reduce employees' burdens and be attractive to them, resulting in successful implementation outcomes and mental health benefits. A pre-post design feasibility study will be conducted on ten companies to evaluate trial methods (e.g., recruitment and procedures). The primary outcome will involve individual-level penetration, defined as the proportion of the number of employees who register for the program divided by the total number of invited employees at the company. The progression criterion to go next trial specifies that more than 50% of the recruited companies obtain 60% individual penetration, which is set based on the findings of the prior survey of employees at MSEs and of interviews of stakeholders involved in this study, and will be measured by LINE system. Finally, acceptability, appropriateness, and feasibility will be measured using internet-based questionnaires and interviews.

DISCUSSION

This pre-post feasibility study for future effectiveness-implementation hybrid type 2 trials will provide in-depth knowledge about the successful implementation of text-based, semi-personalized, self-care mental health interventions in real-world settings using both quantitative and qualitative data.

CONCLUSIONS

This feasibility study will help validate the effectiveness of text-based interventions using a widely used social networking service (SNS) tool for employees in MSEs.

TRIAL REGISTRATION

UMIN clinical trial registration, UMIN000046960. Registered on February 21, 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053570.

The EMPOWER Occupational e-Mental Health Intervention Implementation Checklist to Foster e-Mental Health Interventions in the Workplace: Development Study

BACKGROUND

Occupational e-mental health (OeMH) interventions significantly reduce the burden of mental health conditions. The successful implementation of OeMH interventions is influenced by many implementation strategies, barriers, and facilitators across contexts, which, however, are not systematically tracked. One of the reasons is that international consensus on documenting and reporting the implementation of OeMH interventions is lacking. There is a need for practical guidance on the key factors influencing the implementation of interventions that organizations should consider. Stakeholder consultations secure a valuable source of information about these key strategies, barriers, and facilitators that are relevant to successful implementation of OeMH interventions.

OBJECTIVE

The objective of this study was to develop a brief checklist to guide the implementation of OeMH interventions.

METHODS

Based on the results of a recently published systematic review, we drafted a comprehensive checklist with a wide set of strategies, barriers, and facilitators that were identified as relevant for the implementation of OeMH interventions. We then used a 2-stage stakeholder consultation process to refine the draft checklist to a brief and practical checklist comprising key implementation factors. In the first stage, stakeholders evaluated the relevance and feasibility of items on the draft checklist using a web-based survey. The list of items comprised 12 facilitators presented as statements addressing "elements that positively affect implementation" and 17 barriers presented as statements addressing "concerns toward implementation." If a strategy was deemed relevant, respondents were asked to rate it using a 4-point Likert scale ranging from "very difficult to implement" to "very easy to implement." In the second stage, stakeholders were interviewed to elaborate on the most relevant barriers and facilitators shortlisted from the first stage. The interview mostly focused on the relevance and priority of strategies and factors affecting OeMH intervention implementation. In the interview, the stakeholders' responses to the open survey's questions were further explored. The final checklist included strategies ranked as relevant and feasible and the most relevant facilitators and barriers, which were endorsed during either the survey or the interviews.

RESULTS

In total, 26 stakeholders completed the web-based survey (response rate=24.8%) and 4 stakeholders participated in individual interviews. The OeMH intervention implementation checklist comprised 28 items, including 9 (32.1%) strategies, 8 (28.6%) barriers, and 11 (39.3%) facilitators. There was widespread agreement between findings from the survey and interviews, the most outstanding exception being the idea of proposing OeMH interventions as benefits for employees.

CONCLUSIONS

Through our 2-stage stakeholder consultation, we developed a brief checklist that provides organizations with a guide for the implementation of OeMH interventions. Future research should empirically validate the effectiveness and usefulness of the checklist.

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

Background

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

Aim

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

Methods

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

Results

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

Conclusions

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

Personal, Social, and Workplace Environmental Factors Related to Psychological Well-Being of Staff in University Settings

BACKGROUND

Understanding the psychological well-being (PWB) of university staff and factors that influence it is critical for developing intervention programs that promote PWB and enhance productivity and worker engagement.

PURPOSE

This study aimed to assess the level of PWB in university staff and identify personal, social, and workplace environmental factors related to their PWB.

METHODS

A cross-sectional, correlational study design was used. A convenience sample of university staff was recruited from two universities in Texas. Participants completed an online questionnaire, which included Ryff's PWB scale to measure PWB, along with questions related to personal, social, and workplace factors. Hierarchical multiple regression was used to analyze the influence of these factors on the PWB of university staff.

RESULTS

The PWB of university staff (n = 202) was significantly influenced by personal factors (i.e., race and perceived mental health status), social factors (i.e., social support of friends), and workplace environmental factors (i.e., physical demands).

CONCLUSION/APPLICATION TO PRACTICE

To effectively promote PWB among university staff, occupational health nurses should proactively track and monitor their PWB. Policies and interventions should consider the various personal, social, and workplace environment factors identified in this study, such as mental health, social support resources, and physical demands.

Pragmatic Approach to the Assessment and Use of Digital Mental Health Interventions for Health Workers

Symptoms of poor mental health among working people, especially health workers, are on the rise in the United States, contributing to a burgeoning market of thousands of mental health technology products, few of which have undergone rigorous evaluation. Most research on these products focuses on deploying digital mental health interventions as ancillary support in clinical practice and community settings. Little is known of the effectiveness of these tools when employers offer them. We describe the landscape of digital mental health interventions, providing an overview of mental health conditions that are addressed with technology-based solutions in the workplace and the products and services available. We argue for employers to apply a methodical approach to evaluating and selecting technologies for their organizations, and we review relevant frameworks for evaluation. Considering the rapidly evolving landscape of digital mental health interventions, we offer evidence-informed recommendations to organizations and decision-makers seeking to support workplace mental health and well-being, and we advocate the development of products that help organizations assess how they can mitigate workplace conditions that may contribute to poorer mental health. (Am J Public Health. 2024;114(S2):S171-S179. https://doi.org/10.2105/AJPH.2023.307505).

Self-help digital mental health intervention in improving burnout and mental health outcomes among healthcare workers: A narrative review

Background

Healthcare workers face burnout from high job demands and prolonged working conditions. While mental health services are available, barriers to access persist. Evidence suggests digital platforms can enhance accessibility. However, there is a lack of systematic reviews on the effectiveness of digital mental health interventions (DMHIs) for healthcare professionals. This review aims to synthesize evidence on DMHIs' effectiveness in reducing burnout, their acceptability by users, and implementation lessons learned.

Method

This Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA)-guided review included 12 RCTs on DMHIs for healthcare professionals, published before 31 May 2024. The primary focus was on burnout, with secondary outcomes related to mental health and occupation. Quality appraisal used Cochrane risk of bias tools. A narrative synthesis explored DMHIs' effectiveness, acceptability, utilization, and implementation lessons.

Results

Significant improvements in mental health outcomes were observed in 10 out of 16 RCTs. Burnout and its constructs showed significant improvement in five RCTs. Studies that measured the acceptability of the interventions reported good acceptability. Factors such as attrition, intervention design and duration, cultural sensitivities, flexibility and ease of use, and support availability were identified as key implementation considerations.

Conclusions

Web-based DMHIs positively impact burnout, mental health, and occupational outcomes among healthcare professionals, as shown in most RCTs. Future research should enhance DMHIs' effectiveness and acceptability by addressing identified factors. Increasing awareness of DMHIs' benefits will foster acceptance and positive attitudes. Lessons indicate that improving user engagement and effectiveness requires a multifaceted approach.

Utilization and engagement with an employer-provided digital mental health platform: An international perspective

Objective

This retrospective study (2020-2022) compared the usage patterns across international regions of an employer-provided digital mental health platform, which is available in native languages and offers both self-guided digital activities and one-on-one sessions.

Methods

Routine data from the platform were analyzed by describing the demographic profile of 178,119 users from different geographical regions, their baseline mental health status and burnout levels, as well as patterns of engagement. Statistical analyses were conducted using logistic and ordered logit models to examine the association between cumulative engagement with the platform over time and baseline characteristics.

Results

The platform had high engagement and satisfaction levels across regions and age groups. Female users were more engaged than males in both self-guided digital activities and one-on-one sessions. Older users and those from non-US regions were more engaged in self-guided digital activities, while younger users and those from the US were more engaged in one-on-one sessions. Symptoms of anxiety were also associated with engagement with one-on-one sessions.

Conclusions

The study's findings provide valuable insights into the benefits of digital platforms in addressing mental health needs of employers from different regions. Future research should focus on exploring the specific factors that influence engagement with digital mental health platforms and how these platforms can be optimized and tailored to better serve diverse populations.

Occupational burnout and public stigma associated with employee mental well-being: A multi-industry, cross-sectional study during COVID-19

BACKGROUND

While mental illness (e.g., depression, anxiety) has been examined frequently in the workplace, the COVID-19 pandemic has only increased the attention towards mental illness. Mental well-being views mental health as a continuum from ill health to thriving. Few studies have examined factors associated with mental well-being in the workplace. Public stigma for mental illness, the general population's negative attitude towards mental illness, and occupational burnout are examined.

OBJECTIVE

The purpose of this study was to examine the relationship between burnout and public stigma on mental well-being in a sample of employees across industries in the United States.

METHODS

Employees surveyed from 16 companies from various industries were assessed. Room Here, a non-profit organization whose goal is to improve employee mental fitness, gathered data from these companies located in the western mountain region of the U.S. Data were collected during the pandemic. Across this portfolio of companies, 259 employees were included in the sample. Survey assesses respondents' mental well-being, stigma towards mental illness, and occupational burnout. Ordinary least squares (OLS) regression was used in this cross-sectional study on secondary data.

RESULTS

Results suggested occupational burnout was associated with a decrease in mental well-being, while public stigma was associated with an improvement in mental well-being.

CONCLUSION

This study sought to examine the relationship between mental well-being, burnout, and public stigma. Employee burnout and public stigma were related to mental well-being. Implications for burnout and stigma reduction programs are discussed as well as future research.

Healthcare System Digital Transformation across Four European Countries: A Multiple-Case Study

Digitization has become involved in every aspect of life, including the healthcare sector with its healthcare professionals (HCPs), citizens (patients and their families), and services. This complex process is supported by policies: however, to date, no policy analysis on healthcare digitalization has been conducted in European countries to identify the main goals of digital transformation and its practical implementation. This research aimed to describe and compare the digital health policies across four European countries; namely, their priorities, their implementation in practice, and the digital competencies expected by HCPs. A multiple-case study was performed. Participants were the members of the Digital EducationaL programme invoLVing hEalth profEssionals (DELIVER), a project funded by the European Union under the Erasmus+ programme, involving three countries (Denmark, Italy, and Slovenia) and one autonomous region (Catalonia-Spain). Data were collected using two approaches: (a) a written interview with open-ended questions involving the members of the DELIVER project as key informants; and (b) a policy-document analysis. Interviews were analysed using the textual narrative synthesis and the word cloud policy analysis was conducted according to the Ready, Extract, Analyse and Distil approach. Results showed that all countries had established recent policies at the national level to address the development of digital health and specific governmental bodies were addressing the implementation of the digital transformation with specific ramifications at the regional and local levels. The words "health" and "care" characterized the policy documents of Denmark and Italy (309 and 56 times, 114 and 24 times, respectively), while "development" and "digital" (497 and 478 times, respectively) were common in the Slovenia document. The most used words in the Catalonia policy document were "data" and "system" (570 and 523 times, respectively). The HCP competencies expected are not clearly delineated among countries, and there is no formal plan for their development at the undergraduate, postgraduate, and continuing educational levels. Mutual understanding and exchange of good practices between countries may facilitate the digitalization processes; moreover, concrete actions in the context of HCP migration across Europe for employment purposes, as well as in the context of citizens' migration for healthcare-seeking purposes are needed to consider the differences emerged across the countries.

Mental Health for All: The Case for Investing in Digital Mental Health to Improve Global Outcomes, Access, and Innovation in Low-Resource Settings

Mental health disorders are an increasing global public health concern that contribute to morbidity, mortality, disability, and healthcare costs across the world. Biomedical and psychological research has come a long way in identifying the importance of mental health and its impact on behavioral risk factors, physiological health, and overall quality of life. Despite this, access to psychological and psychiatric services remains widely unavailable and is a challenge for many healthcare systems, particularly those in developing countries. This review article highlights the strengths and opportunities brought forward by digital mental health in narrowing this divide. Further, it points to the economic and societal benefits of effectively managing mental illness, making a case for investing resources into mental healthcare as a larger priority for large non-governmental organizations and individual nations across the globe.

[Analysis of Sickness-Related Days of Absence among Soldiers of the German Armed Forces from 2008 to 2018 Part 1: Retrospective Analysis with Comparison to the Statutory Health Insurance System]

BACKGROUND

Sickness-related absences are of particular importance both in the German armed forces and in the civilian sector.

THE AIM OF THIS STUDY

was to analyze the incidence of sick leave among soldiers in comparison to the working population covered by the statutory health insurance (SHI) system.

METHOD

According to the systematics of the SHI, the key figures on incapacity to work in the period 2008-2018 are calculated in an age- and gender-standardized manner. Likewise, a list of the TOP 20 ICD-10 diagnoses in relation to incapacity to work was determined, and their average annual rates of change were calculated for trend analysis.

RESULTS

The annual rate of sick leave among soldiers was between 1.5 and 2.3%, which was lower than that of the SHI (3.1 to 5.0%). The duration of illness (sick days per case) among soldiers was between 9.0-15.6 days per year, compared with 10.9-14.4 days in the SHI system. The sickness frequency (cases per 100 persons) was lower among soldiers (48.2-75.0 cases) than in the SHI (96.8-131.0 cases). Most days of absence among soldiers were due to "respiratory infections (J06)" with 13.2%, "stress reactions (F43)" with 8.7%, "other infectious gastroenteritis and colitis (A09)" with 6.5%, "back pain (M54)" with 4.4% and "depressive episode (F32)" with 4.0% of all days of absence and were comparable to the values in SHI. "Depressive episode (F32)", "injuries (T14)", sreactions (F43)", "respiratory infections (J06)" and "pregnancy complaints (O26)" showed the highest rates of increase of+6.1% to+3.6% of days off work.

CONCLUSION

For the first time, it was possible to compare the sickness rate of soldiers with that of the general population in Germany, which may also provide indications for further measures for primary, secondary and tertiary prevention. The lower sickness rate among soldiers compared with the general population is mainly due to a lower incidence of illness, with a similar duration and pattern of illness, but with an overall upward trend. The ICD-10 diagnoses "Depressive episode (F32)," "injuries (T14)," "stress reactions (F43)," "acute upper respiratory tract infections (J06)" and "pregnancy complaints (O26)," which are increasing at an above-average rate in relation to the number of days absent, require further analysis. This approach seems promising, for example, to generate hypotheses and ideas for further improvement of health care.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Mediterranean diet and psychological well-being intervention to reverse metabolic syndrome in Chile (CHILEMED trial)

Psychosocial status and lifestyle are key risk factors of non-communicable diseases (NCDs), which, in turn, are main drivers of healthcare costs and morbimortality worldwide, including Chile. Mediterranean diet (MedDiet) is one of the healthiest dietary patterns under study. However, its impact on high-risk conditions, such as metabolic syndrome (MetS), and NCDs outside the Mediterranean Basin remains mostly unexplored. Even though Central Chile has an environment, food production, and culinary traditions comparable to those present in Mediterranean countries, few studies -some with significant methodological limitations- have evaluated the effect of MedDiet on health and/or disease in Chilean subjects. Importantly, a Mediterranean lifestyle is a modus vivendi that integrates physical health with mental and social well-being. Psychological well-being (PWB) is associated with healthy behaviors, positive health outcomes, and longevity, thereby emerging as a novel healthcare goal. We report here an ongoing randomized controlled clinical trial in Chilean patients with MetS seeking to test whether (1) a PWB theory-based intervention facilitates induction to and increases long-term adherence to a locally adapted MedDiet, and (2) a MedDiet intervention -implemented alone or combined with well-being promotion- is more effective at reversing MetS compared to individuals following a low-fat diet without psychological support. The CHILEan MEDiterranean (CHILEMED) diet intervention study is a 1-year trial including patients with MetS living in Chile. Participants will be assigned randomly by a computer-generated random number sequence to one of the three intervention arms: a) low-fat diet as control group, b) MedDiet alone, and c) MedDiet plus well-being support. Patients will be followed-up by individual and/or group online nutritional sessions or phone cal as well as 6- and 12-month in-person re-assessment of medical history, medication use, food intake, PWB, anthropometrics/physical exam, and blood collection for laboratory analysis. The primary outcome of the trial will be the effect of the MedDiet -with or without PWB intervention- on overall reversal of MetS compared to low-fat diet alone. Based on a statistical superiority trial, expected impact, and patient loss, the estimated study sample is 339 subjects (113 individuals per arm in 3 equal-sized groups). Currently, we have enrolled 179 patients, predominantly women, evenly distributed by age (group means ranging from 45.7 to 48,9 years-old), 3/4 are obese with almost all of them showing abdominal obesity, 70% are hypertensive, whereas <10% exhibit diabetes. If findings turn out as expected (e.g., MedDiet -with or without PWB intervention- is better than the low-fat diet for reversion of MetS at 1-year follow-up), CHILEMED will provide further beneficial evidence of the MedDiet on NCD risk conditions beyond the Mediterranean region.

The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019

INTRODUCTION

To promote telehealth implementation and uptake, it is important to assess overall clinical effectiveness to ensure any changes will not adversely affect patient outcomes. The last systematic literature review examining telehealth effectiveness was conducted in 2010. Given the increasing use of telehealth and technological developments in the field, a more contemporary review has been carried out. The aim of this review was to synthesise recent evidence associated with the clinical effectiveness of telehealth services.

METHODS

A systematic search of 'Pretty Darn Quick'-Evidence portal was carried out in November 2020 for systematic reviews on telehealth, where the primary outcome measure reported was clinical effectiveness. Due to the volume of telehealth articles, only systematic reviews with meta-analyses published between 2010 and 2019 were included in the analysis.

RESULTS

We found 38 meta-analyses, covering 10 medical disciplines: cardiovascular disease (n = 3), dermatology (n = 1), endocrinology (n = 13), neurology (n = 4), nephrology (n = 2), obstetrics (n = 1), ophthalmology (n = 1), psychiatry and psychology (n = 7), pulmonary (n = 4) and multidisciplinary care (n = 2). The evidence showed that for all disciplines, telehealth across a range of modalities was as effective, if not more, than usual care.

DISCUSSION

This review demonstrates that telehealth can be equivalent or more clinically effective when compared to usual care. However, the available evidence is very discipline specific, which highlights the need for more clinical effectiveness studies involving telehealth across a wider spectrum of clinical health services. The findings from this review support the view that in the right context, telehealth will not compromise the effectiveness of clinical care when compared with conventional forms of health service delivery.

Practical pathway for the management of depression in the workplace: a Canadian perspective

Major depressive disorder (MDD) and other mental health issues pose a substantial burden on the workforce. Approximately half a million Canadians will not be at work in any week because of a mental health disorder, and more than twice that number will work at a reduced level of productivity (presenteeism). Although it is important to determine whether work plays a role in a mental health condition, at initial presentation, patients should be diagnosed and treated per appropriate clinical guidelines. However, it is also important for patient care to determine the various causes or triggers including work-related factors. Clearly identifying the stressors associated with the mental health disorder can help clinicians to assess functional limitations, develop an appropriate care plan, and interact more effectively with worker's compensation and disability programs, as well as employers. There is currently no widely accepted tool to definitively identify MDD as work-related, but the presence of certain patient and work characteristics may help. This paper seeks to review the evidence specific to depression in the workplace, and provide practical tips to help clinicians to identify and treat work-related MDD, as well as navigate disability issues.

A field experiment on the effects of weekly planning behaviour on work engagement, unfinished tasks, rumination, and cognitive flexibility

This study concerns research on self-regulation. It examines the effects of planning behaviour, a comprehensive self-regulatory strategy of goal setting, planning work steps, and developing alternative plans. Combining different strategies, rather than testing them in isolation, would strengthen their effects and make them more appropriate for complex work tasks. Drawing on self-regulation theory, we propose that planning behaviour positively affects work engagement, unfinished tasks, rumination, and cognitive flexibility. Considering cognitive flexibility as an outcome provides insight into the cognitive benefits of planning behaviour. We examine person-level cognitive demands of flexible work and predictability as moderator variables to better understand the role of contextual variables in the use of self-regulatory strategies at work. We conducted a field experiment (N = 208 individuals; 947 weekly entries) in which we manipulated employees' weekly planning behaviour in their daily work lives. We found negative effects on unfinished tasks and weekly rumination, and positive effects on weekly cognitive flexibility. No significant moderating effects were found. Our study suggests that a brief planning manipulation at the beginning of the week may have multiple benefits and may be an important tool for improving cognitive flexibility. Future research should examine the role of time and mediating variables.