Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials

Sources of Distress for Secure Mental Healthcare Staff: A Cross-Sectional Study of the Impact of Personal and Occupational Problems on Psychological Wellbeing and Functioning

Despite a global drive to improve staff well-being in healthcare, distress and absenteeism continue to persist, posing consequences for patient care and organisational functioning. Current research and subsequent strategies implemented to remediate such problems have primarily focused on occupational experiences, disregarding the contribution of problems occurring outside of the workplace. The current study sought to establish the prevalence of work and non-work problems, and their respective impacts on several well-being outcomes, in this occupational group. Secondary analysis of data from a cross-sectional survey of 323 staff in a secure UK mental healthcare organisation was conducted. Exposure to non-work problems was pervasive across the sample (79.3%). Demographic discrepancies in exposure to types of problems were apparent, though number of problems reported was comparable across the sample. Number of non-work problems was a significant predictor of depression, anxiety, functional impairment, and complex post-traumatic stress disorder symptoms, when controlling for exposure to work problems. The findings implicate the need for a broader conceptualisation of distress in secure mental healthcare staff, who typically report exposure to several non-work problems, in the context of occupational challenges. Policy, practice and service implications are discussed, with consideration for the availability and modality of support offered to staff.

A Review of Workplace Tuberculosis Policies in Selected Low- and Middle-Income Countries in Asia-Pacific

Background and Objective

The World Health Organization (WHO) reported that most of the tuberculosis (TB) cases are aged between 15 to 54 years old, the working population. This study described workplace policies on TB in selected low- and middle-income countries (LMIC) in Asia-Pacific.

Methods

Among the LMICs, countries wherein TB is a public health concern were included. Six policies written in English were included in this study and were reviewed based on the components of the TB workplace programs that were extracted from the WHO Guidelines for Workplace TB Control Activities.

Results

The Philippine policy had the most number of components while those of Cambodia and Papua New Guinea had the least. Only the component on implementing environmental controls was common among the policies. Components on respecting patient rights and confidentiality, tailoring of workload to TB patient's state of health, registration of all patients with TB diagnosis, reporting of cases to central NTP office, recording of standard treatment outcome, and inclusion of multidrug-resistant TB (MDR-TB) provisions were missing for the majority of the policy documents.

Conclusion

The workplace TB program policies included in this study can be reviewed and updated accordingly, with the coverage expanding to all workplaces. The policies can also integrate measures on COVID-19 as the pandemic has slowed the progress in TB control. With the similarities in the preventive measures against TB and COVID-19, this can be an avenue to develop integrated policies especially for workplaces.

Addressing the mental health needs of healthcare professionals in Africa: a scoping review of workplace interventions

Healthcare workers in Africa face considerable stress due to factors like long working hours, heavy workloads and limited resources, leading to psychological distress. Generally, countries in the global north have well-established policies and employee wellness programs for mental health compared to countries in the global south. This scoping review aimed to synthesize evidence from published and grey literature on workplace mental health promotion interventions targeting African healthcare workers using Social Ecological Model (SEM) and the Job Demands-Resources (JD-R) model as an underlying theoretical framework for analysis. Arksey and O'Malley framework for scoping reviews was used. The search was conducted across multiple databases. A total of 5590 results were retrieved from Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, Cochrane Library, CINAHL, Scopus and Web of Science. Seventeen (17) studies from ten (10) African countries were included after title, abstract and full text screening. Thematic analysis identified 5 key themes namely training programs, counselling services, peer support programs, relaxation techniques and informational resources. In conclusion, even though limited workplace mental health interventions for healthcare professionals were identified in Africa, individual-level interventions have been notably substantial in comparison to organizational and policy-level initiatives. Moving forward, a multi-faceted approach unique to the African context is essential.

Measurement and Evaluation of Health, Functional Capacity, Physical Fitness, and Daily Habits of Greek Female Healthcare Professionals Working in a Hospital Environment

BACKGROUND/OBJECTIVES

The wellness profile of healthcare professionals is of crucial importance since it can affect the quality of healthcare services. This study created a comprehensive profile of health, functional capacity, physical fitness, and lifestyle behaviours in hospital healthcare professionals.

METHODS

A hundred female (age: 45.53 ± 2 yrs) professionals underwent assessments of their health (respiratory function/blood pressure/body circumference/body fat/body mass index/musculoskeletal pains), functional capacity (flexibility/balance), physical fitness (strength/aerobic capacity), and daily habits (smoking/alcohol/caffeinated beverages/screen time/physical activity).

RESULTS

According to data analysis (descriptive statistics, paired t-tests to analyze possible differences between the right and left sides), (a) 39% of the participants were overweight and 28% obese, (b) 40-44% of the participants showed higher values than normal in waist circumference and systolic blood pressure, and (c) 96% of the participants showed musculoskeletal pains. Functional capacity and physical fitness demonstrated significant differences in balance and flexibility (p < 0.05) between sides (right/left) and low levels of strength and dynamic balance-agility. Moreover, 67% of the sample did not participate in physical activities, while a significant percentage showed increased screen time on weekdays (44%) and weekends (61%). Finally, 36% of the sample smoked, 62% consumed alcohol, and 92% consumed caffeinated beverages (the majority were within permissible limits).

CONCLUSIONS

In conclusion, this study contributes valuable insights into the wellness profile of healthcare professionals to ensure optimal care for this population.

Workplace Health and Wellbeing in Small and Medium Sized Enterprises (SMEs): A Mixed Methods Evaluation of Provision and Support Uptake

Today's challenging times highlight the need for workplaces to support employee wellbeing. Workplaces can offer a means to improve employee wellbeing and promote health initiatives. However, small and medium-sized enterprises (SMEs) are less likely than larger organizations to engage with workplace wellbeing initiatives or offer wellbeing provision. This study, conducted in an urban area in central England, explores SME engagement with local government workplace wellbeing provision, and barriers and facilitators to SME engagement, SME implementation of wellbeing provision, and employee uptake. A mixed-methods design was used. Quantitative data were collected via a survey of 103 SMEs and qualitative data from three focus groups with stakeholders involved in promoting SME engagement with wellbeing support (n = 9) and 16 in-depth interviews with SME representatives (n = 8) and employees (n = 8). Quantitative data were analyzed using the chi-squared, Fisher's exact and Mann-Whitney U tests, and multivariable logistic regression. Qualitative data were analyzed using framework analysis. Findings highlighted several interrelated factors acting as barriers and facilitators to SME engagement with wellbeing initiatives, SME-provided wellbeing provision, and employee uptake. The study provides valuable insights for policymakers, public health teams, and SME leaders on improving provision of and engagement with wellbeing programs. Trust, awareness, knowledge, and communication are highlighted as important prerequisites of optimal provision and engagement.

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.

What alleviates the harmful effect of strain on recovery from work of 4478 health and social services workers? A cross-sectional study

AIM

To analyse whether the harmful effect of job demands on recovery can be alleviated by healthy lifestyle, psychological recovery experiences and job resources. We also describe their prevalence among employees in different types of eldercare service and in the health and social services sector in general.

DESIGN

Cross-sectional study.

METHODS

The data were collected using a self-report survey in 2020 in the health and social services sector organizations (n = 4478). Employees were classified as the following service types: general health and social services (N = 3225), home care (N = 452), service housing (N = 550) and outpatient and ward care (N = 202). The data were analysed using percentages, cross-tabulations and logistic regression analysis.

RESULTS

Poor recovery, high job demands, low appreciation and low autonomy in terms of worktime and breaks were more prevalent in eldercare. Employers could alleviate the risk of high job demands by offering job resources-appreciation, autonomy in terms of worktimes and breaks-and motivating employees to maintain healthy lifestyle habits and use recovery experiences such as relaxation.

CONCLUSION

The study emphasizes the importance of appreciation in the health and social services sector context. Even with moderate levels of appreciation employers can protect employees from poor recovery from work in the demanding health and social services work environment.

IMPACT

Eldercare employees face continuous and accumulating work strain at the same time as the sector struggles against a labour shortage. One way to prevent the harmful consequences of strain is to enhance recovery from work. Employers could alleviate the risk of high job demands and poor recovery by showing appreciation and giving employees more autonomy in terms of work time and breaks during the workday. This could also motivate employees to keep up healthy lifestyle habits and use their recovery experiences. Results are important especially in the daily management of HSS work. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Managers in the health and social services sector and eldercare can use these findings to promote recovery from work.

REPORTING METHOD

STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Towards a Thriving Workplace: A Feasibility Study on Mindfulness and the Mediterranean Lifestyle for Corporate Wellness

Background/Objectives: This study explores the potential of integrating mindfulness and the Mediterranean lifestyle into corporate wellness programs to enhance workplace well-being. Methods: A survey of 485 employees from Greece and Cyprus examined how mindfulness, resilience, adherence to the Mediterranean lifestyle, and work ability are connected. Results: Pearson correlation analysis showed statistically significant positive relationships between mindfulness, resilience, and work ability (p < 0.001 and p < 0.001, respectively). Mindfulness was associated with higher job satisfaction (p < 0.001) and was a significant predictor of good (OR = 1.112, 95% CI: 1.043-1.186, p = 0.001) and excellent (OR = 1.163, 95% CI: 1.087-1.245, p < 0.001) work ability, while adherence to the Mediterranean lifestyle had a lower yet significant positive correlation with resilience (p < 0.01) and work ability (p < 0.05). Differences in wellness across job sectors were observed: employees in health and retail sectors had lower resilience, work ability, and mindfulness compared to those in manufacturing, technology, education, and services. Notably, 78% of participants expressed interest in future wellness programs, favoring a combination of online and onsite formats. Conclusions: These findings suggest that mindfulness and the Mediterranean lifestyle can enhance employee well-being and productivity, but sector-specific strategies may be necessary to address unique challenges. Practical applications include tailoring interventions to meet the needs of employees in sectors with lower wellness scores. Future research should investigate the long-term benefits of such programs across diverse industries and employee groups.

Development of the process of determining essential hazardous psychosocial factors of employee stress risk

The purpose of the study is to determine the impact of hazardous psychosocial factors on stress among employees when performing production tasks to develop recommendations for reducing their impact. Based on the recommendations of the ISO 45003:2021 standard, a special questionnaire was developed to determine hazardous psychosocial factors that lead to the appearance of worker's stress, the answers to which were evaluated on a Likert scale with points from 0 to 4. 68 workers (23 men and 45 women) aged 20 to 45 took part in the survey conducted at industrial enterprises of the Dnipro region in May-June 2023. A questionnaire was developed to identify significant psychosocial hazardous factors in personnel at an industrial enterprise, which includes three groups of psychosocial hazardous factors and consists of thirty questions. A ten-step process for managing significant hazardous psychosocial risks is proposed. It was established that women pay more attention to challenges (psychosocial hazardous factors) that are associated with the organization of work (uncertainty at work, lack of breaks due to workload) and social problems (disrespect, disrespect and inattention to employees, unreasonable behavior towards you by leadership); for men, a significant group of hazardous psychosocial factors is-equipment, working environment, hazardous tasks (fear of performing hazardous work; work is associated with a significant risk to life). The novelty consists in the justification of the process of identifying essential psychosocial factors, which will allow managers to systematically monitor the state of mental health of employees, the psychological climate in the organization and respond in a timely manner to expected problems and develop corrective actions to normalize the situation. The process of managing significant hazardous psychosocial risks has been developed, which consists of ten steps and differs from the known procedure of identifying significant hazardous psychosocial factors on a Likert scale, considering the answers of women and men.

VUCA in the present-day health workplace and the mental health and wellbeing of health care workers: a systematic scoping review

BACKGROUND

The health workplace is fraught with fluctuations and uncertainties, creating a volatile, uncertain, complex, and ambiguous (VUCA) environment, particularly impacting frontline healthcare workers (HCWs) and leading to an epidemic of stress, burnout and health issues, exacerbated by the COVID-19 pandemic.

OBJECTIVES

This paper aims to explore the multifaceted aspects of HCWs wellbeing, address challenges arising due to COVID-19 and VUCA and highlight innovative approaches within health systems to enhance the quality of life HCWs.

METHODS

A systematic review was conducted using PubMed and Scopus with search terms including 'VUCA,' 'health personnel,' 'frontline healthcare workers,' and 'psychological wellbeing.' Grey literature focusing on Australia and Nigeria was also included. Search was limited to titles on "COVID-19", articles published in English, and articles published from inception to 11th March 2024.

FINDINGS

Initial search terms generated hundreds of thousands of literatures but after limitations to titles on COVID-19, 32 articles were screened and 22 selected for critical review. Seven other grey articles were included with focus on Australia and Nigeria. The summary findings indicate the disruptiveness of VUCA, and associated need to improve healthcare workers' resilience and this calls for further research.

CONCLUSION

This report highlights the further need to explore the volatile, uncertain, complex and/or ambiguous health workplace with a view to improve healthcare workers wellbeing. Intentional organizational support strategies along with personal coping strategies should be further explored towards improving HCWs resilience and wellbeing.

Leveraging Telemedicine for Disaster Response: Longitudinal Study on Return-to-Work Programs During the COVID-19 Crisis

OBJECTIVE

Since COVID-19, Indonesia has legalized telemedicine in medical services, including Return to Work (RTW). RTW programs help occupational injury-disabled workers return to work. This research examines how telemedicine supports RTW for employees with occupational injuries.

METHODS

The study used Interrupted Time Series Analysis (ITSA) to find patterns and trends in RTW program telemedicine case numbers and claim settlements over time. A total of 1 314 data were obtained from the Indonesian National Social Security Agency on Employment (BPJS Ketenagakerjaan) from July 1, 2015, to December 2022.

RESULTS

Telemedicine reduces the frequency of recurrent occupational injuries in persons with impairments (Relative Risk [RR] = 0.59). In addition, the integration of telemedicine into health care practices exhibits promising prospects in terms of mitigating the financial burden on social security programs. This is supported by a robust RR (0.6).

CONCLUSIONS

Telemedicine reduced the number of repeat cases and optimized medical claims cost in the RTW program during the COVID-19 pandemic. The results will contribute to policy and assist health care professionals and employers in improving RTW outcomes for disabled people.

The Evaluation of a Mindful Coaching Programme to Reduce Burnout in Social Workers in Hong Kong-A Pilot Study

Social work professionals experience high levels of burnout, emotional exhaustion, and secondary traumatic stress (STS). This paper reports the findings of a pilot test of the Burn-Not-Out programme that aimed to reduce social workers' burnout, STS, and depressive symptoms and to enhance compassion satisfaction (CS), using the mixed methods evaluation methodology. Hong Kong social workers participated in the programme between December 2023 and March 2024 and completed pre- and post-programme self-administered online surveys including the Professional Quality of Life (ProQOL) and Patient Health Questionnaire (PHQ-9), healthy alongside self-constructed questions on boundary setting, and post-programme online focus group discussions. The results from 94 paired surveys revealed a concerning mental health profile of the participants at baseline, and, after programme participation, there were statistically significant reductions in burnout (Cohen's d = 0.73) and depressive symptoms (Cohen's d = 0.57) among the participants. The participants in the focus group reported that they valued the programme's emphasis on healthy boundaries, one-on-one coaching, and the sense of being cared for, which contributed to their mental health improvement. This study highlights the urgent need for more research on the role of psychological capital in social workers' resilience and calls for more empirical systemic interventions that can promote social workers' mental wellness, with sustainable policies that ensure manageable workloads and adequate workplace support.

General practitioner and nurse experiences of type 2 diabetes management and prescribing in primary care: a qualitative review following the introduction of funded SGLT2i/GLP1RA medications in Aotearoa New Zealand

AIM

To explore the views of general practitioners (GPs) and nurses on type 2 diabetes (T2D) management, including the use of recently funded T2D medications in New Zealand (NZ) and their perceived barriers to providing optimal care.

BACKGROUND

T2D is a significant health concern in NZ, particularly among Māori and Pacific adults. Characterised by prolonged hyperglycaemia, T2D is generally a progressive condition requiring long-term care.

METHODS

Semi-structured interviews were conducted between July and December 2022 with 21 primary care clinicians (10 GPs and 11 nurses/nurse prescribers) from nine different general practice clinics across the Auckland and Waikato regions of NZ. Framework analysis was conducted to identify common themes in clinicians' perceptions and experiences with T2D management.

FINDINGS

Three themes were identified: health-system factors, new medications, and solution-based approaches. Lack of clinician time, healthcare funding, staff shortages, and burn-out were identified as barriers to T2D management under health-system factors. The two newly funded medications, empagliflozin and dulaglutide, were deemed to be a positive change for T2D care in that they improved patient satisfaction and clinical outcomes, but several clinicians were hesitant to prescribe these medications. Participants suggested that additional education and specialist diabetes support would be helpful to inform optimal medication prescribing and that better use of a multi-disciplinary team (clinical and support staff) could support T2D care by reducing workload, addressing cultural gaps in healthcare delivery, and reducing burnout. An improved primary care work environment, including appropriate professional development to support prescribing of new medications and the value of collaboration with a non-regulated workforce, may be required to facilitate optimal T2D management in primary care. Future research should focus on interventions to increase support for both clinical teams and patients while adopting a culturally appropriate approach to increase patient satisfaction and improve health outcomes.

A Multi-Wave Study of Factors Associated With Resident Engagement, Depression, Burnout, and Stay Intent

Background

Many studies have documented the epidemic of mental ill-being among resident physicians, but fewer have focused on mental well-being or on guiding intervention design to make progress toward positive change in residency programs to support resident thriving. Informed by the job demands-resources model (JD-R) and positive psychology, the current study examines 4 potential predictors of residents' ill-being (burnout, depression) and well-being (engagement, stay intent) that are malleable and thus capable of change through intervention: psychological capital (PsyCap), supervising physicians' autonomy-supportive leadership style (ASL), social support, and meaningful work.

Methods

Three waves of data were collected between November 2017 and September 2018 at a large hospital system in the United States. Due to participant response rates, we were unable to conduct a planned longitudinal analysis. Therefore, for each wave, Bayesian regression analyses were used to examine cross-sectional relationships between the 4 predictors and each outcome.

Results

Although findings varied across the study's 3 waves, the outcomes were largely as expected. With only 1 exception (depressive symptoms in Wave 2), meaningful work significantly predicted all outcome variables in the expected direction across all 3 waves. PsyCap significantly predicted burnout, depressive symptoms, and engagement in the expected direction across all 3 waves. ASL significantly predicted engagement in the expected direction across all 3 waves, as well as depressive symptoms and stay intent in 2 waves, and burnout in 1 wave. Social support significantly negatively predicted depressive symptoms in all 3 waves and burnout in 1 wave.

Conclusion

Applying the JD-R framework and a positive psychology lens can open new pathways for developing programming to support resident thriving. Meaningful work, PsyCap, ASL, and social support all significantly predicted 1 or more outcomes related to resident thriving (burnout, depression, engagement, stay intent) across all 3 waves. Thus, this study provides theoretical and practical implications for future intervention studies and designing current programming for resident thriving.

Associations between COVID-19 Pandemic-Related Overtime, Perceived Chronic Stress and Burnout Symptoms in German General Practitioners and Practice Personnel-A Prospective Study

BACKGROUND

The mental burdens of general practitioners (GPs) and practice assistants (PrAs) during the COVID-19 pandemic are well investigated. Work-related conditions like overtime are known to contribute to perceived chronic stress and burnout symptoms. However, there is limited evidence regarding the specific mechanisms, which link pandemic-related overtime, chronic stress and burnout symptoms. This study used data from the IMPROVEjob trial to improve psychological well-being in general practice personnel.

METHODS

This prospective study with 226 German GPs and PrAs used the baseline (pre-pandemic: October 2019 to March 2020) and follow-up data (pandemic: October 2020 to April 2021) of the IMPROVEjob trial. Overtime was self-reported as hours above the regular work time. Perceived chronic stress was assessed using the Trier Inventory for the Assessment of Chronic Stress Screening Scale (TICS-SSCS), while burnout symptoms were evaluated using a short version of the Maslach Burnout Inventory (MBI). A mediation analysis investigated the differences of the three main variables between pre-pandemic and pandemic periods.

RESULTS

Burnout symptoms increased significantly from baseline to follow-up (p = 0.003). Overtime correlated positively with burnout symptoms (Total Effect: 0.13; 95% CI: 0.03, 0.23). Decomposition of the total effect revealed a significant indirect effect over perceived chronic stress (0.11; 95% CI: 0.06, 0.18) and no significant direct effect (0.02; 95% CI: -0.08, 0.12), indicating a full mediation.

CONCLUSION

In this large longitudinal study, pandemic-related overtime led to significantly higher levels of burnout symptoms, linked by a pathway through perceived chronic stress. Future prevention strategies need to aim at reducing the likelihood of overtime to ensure the mental well-being of practice personnel.