@Article{info:doi/10.2196/70473,
author="Watanabe, Kazuhiro
and Sato, Mitsuhiro
and Okusa, Shoichi
and Tsutsumi, Akizumi",
title="Effectiveness and Implementation Outcomes of an mHealth App Aimed at Promoting Physical Activity and Improving Psychological Distress in the Workplace Setting: Cluster-Level Nonrandomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2025",
month="May",
day="6",
volume="13",
pages="e70473",
keywords="eHealth",
keywords="behavioral change",
keywords="mobile phone",
keywords="smartphone",
keywords="workplace",
keywords="depression",
keywords="anxiety",
abstract="Background: Encouraging physical activity improves mental health and is recommended in workplace mental health guidelines. Although mobile health (mHealth) interventions are promising for physical activity promotion, their impact on mental health outcomes is inconsistent. Furthermore, poor user retention rates of mHealth apps pose a major challenge. Objective: This study aimed to examine the effectiveness and implementation outcomes of the smartphone app ASHARE in Japanese workplace settings, leveraging a deep learning model to monitor depression and anxiety through physical activity. Methods: This hybrid effectiveness-implementation trial was a 3-month nonrandomized controlled trial conducted from October 2023 to September 2024. Work units and employees were recruited and allocated to the intervention or active control group based on preference. The intervention group installed the ASHARE app, whereas the control group participated in an existing multicomponent workplace program promoting physical activity. Changes in physical activity and psychological distress levels were compared between the groups. User retention rates, participation rates, acceptability, appropriateness, feasibility, satisfaction, and potential harm were also assessed. Results: A total of 84 employees from 7 work units participated (67 from 5 units in the intervention group and 17 from 2 units in the control group). In total, 78 employees completed the 3-month follow-up survey (follow-up rate: 93\%). Both groups showed increased physical activity, and the intervention group showed reduced psychological distress; however, the differences between groups were not statistically significant (P=.20; P=.36). In a sensitivity analysis of protocol-compliant employees (n=21), psychological distress levels were significantly reduced in the intervention group compared with the control group (coefficient=?3.68, SE 1.65; P=.03). The app's 3-month user retention rate was 20\% (12/61), which was lower than the participation rate in each component of the control programs. Implementation outcomes evaluated by employees were less favorable in the intervention group than in the control group, whereas health promotion managers found them to be similar. Conclusions: The ASHARE app did not show superior effectiveness compared with an existing multicomponent workplace program for promoting physical activity. An implementation gap may exist between health promotion managers and employees, possibly contributing to the app's low user retention rate. Future research should focus on examining the effectiveness of strategies to get engagement from managers and from segments of employees with favorable responses in the workplace at an early stage. Trial Registration: UMIN-CTR UMIN000052374; https://tinyurl.com/4x4dxfv6 ",
doi="10.2196/70473",
url="https://mhealth.jmir.org/2025/1/e70473"
}


@Article{info:doi/10.2196/65750,
author="Sevov, Benedict
and Huettemann, Robin
and Zinner, Maximillian
and Meister, Sven
and Fehring, Leonard",
title="Employee Preference and Use of Employee Mental Health Programs: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2025",
month="May",
day="5",
volume="12",
pages="e65750",
keywords="digital health",
keywords="mental health",
keywords="workplace",
keywords="employee well-being",
keywords="employee mental health programs",
keywords="intention to use",
keywords="facilitators and barriers",
keywords="mixed methods",
abstract="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. ",
doi="10.2196/65750",
url="https://humanfactors.jmir.org/2025/1/e65750"
}


@Article{info:doi/10.2196/68546,
author="Ahmadi Shad, Maryam
and Simon, Michael
and Liberatore, Florian",
title="The Impact of Online Labor Platforms on Workforce Management in Health Care",
journal="Interact J Med Res",
year="2025",
month="May",
day="2",
volume="14",
pages="e68546",
keywords="online labor platform",
keywords="temporary work",
keywords="workforce management",
keywords="gig work",
keywords="health care",
keywords="personnel staffing and scheduling",
doi="10.2196/68546",
url="https://www.i-jmr.org/2025/1/e68546"
}


@Article{info:doi/10.2196/60806,
author="Guastella, J. Adam
and Hankin, Lorna
and Stratton, Elizabeth
and Glozier, Nick
and Pellicano, Elizabeth
and Gibbs, Vicki",
title="Improving Accessibility for Work Opportunities for Adults With Autism in an End-to-End Supported Workplace Program: Protocol for a Mixed Methods Cohort Study",
journal="JMIR Res Protoc",
year="2025",
month="May",
day="1",
volume="14",
pages="e60806",
keywords="autism",
keywords="neurodiversity",
keywords="inclusive workplace",
keywords="recruitment",
keywords="job retention",
keywords="accessibility",
keywords="work opportunities",
abstract="Background: Adults with autism have a strong desire and need for employment that matches their strengths, skills, and interests. Yet, they are more likely to be un- or underemployed than their neurotypical peers. Facilitators to successful employment include positive attitudes toward and awareness of autism in the workplace, and provision of adequate support and accommodations, including mental health support. Despite previous workplace programs identifying the need for adapted recruitment and interviewing processes, awareness training, and ongoing employee support, there are no programs that specifically provide these supports and adaptations for employees with autism. Objective: In this study protocol, we describe a framework for a new end-to-end supported workplace program for adults with autism that encompasses 8 key areas to promote inclusive workplaces and improve recruitment and retention of employees with autism. Methods: Candidates with autism (n=15) will complete 2 workplace skills training sessions at the University of Sydney's Brain and Mind Centre, before attending a tailored interview, onboarding session, and paid 12-week placement at consulting firm Ernst and Young (EY). EY managers and colleagues (n=30) will complete a half-day awareness and inclusion training program before supporting the adults with autism through their 12-week placements. Tailored mental health support will also be provided. This mixed methods cohort study will assess the change in the daily functioning and well-being of employees with autism, as well as the change in the managers' and colleagues' knowledge, attitude, and confidence in working with adults with autism following the training programs. These changes will be analyzed using repeated measures of ANOVAs. Results: Data collection for this study was completed in February 2022. As of November 2024, data analysis was in progress. This study is expected to be submitted for publication in June 2025. Conclusions: This study holds the potential to enhance the recruitment and retention of adults with autism, as well as their overall experience in the workplace. International Registered Report Identifier (IRRID): DERR1-10.2196/60806 ",
doi="10.2196/60806",
url="https://www.researchprotocols.org/2025/1/e60806",
url="http://www.ncbi.nlm.nih.gov/pubmed/40310673"
}


@Article{info:doi/10.2196/66791,
author="Ristow, Nele
and Wilke, Annika
and Skudlik, Christoph
and John, Malte Swen
and Ludewig, Michaela",
title="User Experience of and Adherence to a Smartphone App to Maintain Behavior Change and Self-Management in Patients With Work-Related Skin Diseases: Multistep, Single-Arm Feasibility Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="18",
volume="9",
pages="e66791",
keywords="user experience",
keywords="mobile health",
keywords="mHealth",
keywords="app",
keywords="smartphone",
keywords="complex intervention",
keywords="Template for Intervention Description and Replication",
keywords="behavior change techniques",
keywords="behavior change",
keywords="skin diseases",
keywords="occupational dermatology",
keywords="artificial intelligence",
abstract="Background: Smartphone apps are a growing field supporting the prevention of chronic diseases. The user experience (UX) is an important predictor of app use and should be considered in mobile health research. Long-term skin protection behavior is important for those with work-related skin diseases. However, altering health behavior is complex and requires a high level of self-management. We developed a maintenance program consisting of the Mein Hautschutz im Alltag (MiA; ``My skin protection in everyday life'') app combined with an individual face-to-face goal-setting interview to support patients in the implementation of skin protection behavior after inpatient rehabilitation. Objective: The objectives of this paper are to (1) describe the intervention in a standardized manner; (2) evaluate the UX, subjective quality, and perceived impact of the MiA app; and (3) evaluate the adherence to the MiA app. Methods: We followed a user-centered and multistage iterative process in 2 steps that combined qualitative and quantitative data. The maintenance program was tested over 12 weeks after discharge from rehabilitation. The UX, subjective quality, and perceived impact were evaluated formatively based on the user version of the Mobile Application Rating Scale after 12 weeks (T2). Adherence was measured using the frequency of interactions with the app. Results: In total, 42 patients took part (with a dropout rate of n=18, 43\% at T2). The average age was 49.5 (SD 13.1) years, and 57\% (24/42) were male. We found high ratings for the UX, with an average score of 80.18 (SD 8.94) out of a theoretical maximum of 100, but there were a few exceptions in the usability and interaction with the app. The app was most frequently rated with 4 out of 5 stars (15/24, 65\%), which indicates a high subjective quality. Furthermore, the app seemed to influence important determinants to implement skin protection behavior. Adherence to skin protection tracking was higher over the study period than adherence to skin documentation and goal assessment. The number of adherent participants to skin protection tracking was higher in the skin care and skin cleansing categories (28/42, 67\% each) compared to the skin protection category (13/42, 31\%) on day 1 and decreased until day 84 in all dimensions (12/42, 29\% each for skin care and skin cleansing; 9/42, 21\% for skin protection). Conclusions: The results in terms of adherence met the expectations and were consistent with those of other studies evaluating the use of apps for chronic diseases. Interaction with the app could be increased using artificial intelligence to determine eczema severity via photos. It should be investigated which subgroups have difficulties with usability to individualize the support to a greater degree during onboarding. There is a need for further research regarding the effectiveness of the MiA app on skin protection behavior, quality of life, and eczema severity. ",
doi="10.2196/66791",
url="https://formative.jmir.org/2025/1/e66791"
}


@Article{info:doi/10.2196/62778,
author="Jiang, Jiaqi
and Li, Shanghao
and Li, Xian
and Xu, Yingxin
and Zhao, Jian
and An, Pengcheng",
title="Playful Antisedentary Interactions for Online Meeting Scenarios: A Research Through Design Approach",
journal="JMIR Serious Games",
year="2025",
month="Apr",
day="18",
volume="13",
pages="e62778",
keywords="gamification",
keywords="sedentary behavior",
keywords="videoconferencing",
keywords="exertion games",
keywords="embodied interaction",
keywords="design research",
abstract="Background: Online meetings have become an integral part of daily life for many people. However, prolonged periods of sitting still in front of screens can lead to significant, long-term health risks. While previous studies have explored various interventions to address sedentary lifestyles, few have specifically focused on mitigating sedentary behavior during online meetings. Furthermore, design opportunities to address this issue in the context of online meetings remain underexplored. Objective: This study aims to investigate the design of effective antisedentary interactions for online meeting scenarios and understand user experiences with gamified bodily interactions as an antisedentary measure during online meetings. Methods: This study adopts a ``research through design'' approach to develop and explore user experiences of gamified bodily interactions as interventions to mitigate sedentary behavior during online meetings. In collaboration with 11 users, we co-designed and iterated 3 prototypes, which led to the development of the Bodily Interaction Gamification towards Anti-sedentary Online Meeting Environments (BIG-AOME) framework. Using these prototypes, we conducted user studies with 3 groups totaling 15 participants. During co-design and evaluation, all group semistructured interviews were transcribed into written format and analyzed using a conventional qualitative content analysis method. Results: The findings demonstrate that gamified bodily interactions encourage users to engage in physical movement while reducing the awkwardness of doing so during online meetings. Seamless integration with meeting software and the inclusion of long-term reward mechanisms can further contribute to sustained use. In addition, such games can serve as online icebreakers or playful tools for decision-making. Drawing from 3 design prototypes, this study offers a comprehensive analysis of each design dimension within the BIG-AOME framework: bodily engagement, attention, bodily interplay, timeliness, and virtual and physical environments. Conclusions: Our research findings indicate that antisedentary bodily interactions designed for online meetings have the potential to mitigate sedentary behaviors while enhancing social connections. Furthermore, the BIG-AOME framework that we propose explores the design space for antisedentary physical interactions in the context of online meetings, detailing pertinent design choices and considerations. ",
doi="10.2196/62778",
url="https://games.jmir.org/2025/1/e62778"
}


@Article{info:doi/10.2196/67120,
author="Conner, Reagan
and Porter, Cynthia
and Lutrick, Karen
and Beitel, C. Shawn
and Hollister, James
and Healy, Olivia
and Kern, J. Krystal
and Wardenaar, Floris
and Gulotta, J. John
and Jack, Kepra
and Huentelman, Matthew
and Burgess, L. Jefferey
and Furlong, Melissa",
title="Interventions to Reduce Serum Per- and Poly-Fluoroalkyl Substances Levels, Improve Cardiovascular Risk Profiles, and Improve Epigenetic Age Acceleration in US Firefighters: Protocol for Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Apr",
day="16",
volume="14",
pages="e67120",
keywords="firefighters",
keywords="PFAS",
keywords="epigenetics",
keywords="phenotype",
keywords="heart disease",
keywords="cardiovascular disease",
keywords="CVD",
keywords="atherosclerosis",
keywords="occupational health",
keywords="RCT",
keywords="cardiovascular",
keywords="fasting",
keywords="exercise",
abstract="Background: Occupational cancer and acute cardiac events are the leading causes of death among firefighters. Increased exposure to toxicants on the fire ground, such as polycyclic aromatic hydrocarbons, benzene, and per- and poly-fluoroalkyl substances (PFAS), has been linked to certain cancers, cardiovascular disease, accelerated epigenetic aging, and other adverse health effects. PFAS are a major concern because they are persistent, can bioaccumulate, and are present in several firefighting tools. Compared to the general population, firefighters have elevated serum levels of some types of PFAS. A randomized clinical trial in Australian firefighters found that routine blood and plasma donation for 1 year led to decreased serum PFAS levels, although health outcomes were not directly measured in that study. Objective: In collaboration with fire service leadership in Arizona, the Firefighter Collaborative Research Project (FCRP) was established to evaluate the effectiveness of 3 interventions in a randomized controlled trial design to reduce serum PFAS levels, reduce cancer and cardiovascular risk, and improve overall health and wellness in US firefighters. Methods: This study aimed to recruit and enroll up to 1500 active firefighters between August 2023 and October 2024. Between August 2023 and October 2024, active firefighters were recruited and randomized into a study arm based on their eligibility, including serum PFOS levels, for the specific arms. The trial arms include (1) blood and plasma donation, (2) zone 2 physical activity, and (3) intermittent fasting. FCRP outcomes include serum PFAS reduction (arm 1), epigenetic age acceleration (all arms), cardiovascular conditioning (arm 2) and cognitive outcomes (all arms), mental health (all arms), and overall disease risk (all arms). Each study arm includes an intervention and a control group. At enrollment and end of the study, participants provide blood and urine samples and complete a comprehensive questionnaire on their occupational and health history, exposures, and lifestyle behaviors. At the end of the study, participants also participated in a cognitive evaluation. Depending on the study arm, participants may additionally complete a cardiopulmonary exercise test at baseline and follow-up, a mid-study survey, and a mid-study blood and urine collection. Results: Participant activities and data collection will conclude by December 2025. Conclusions: The FCRP is a randomized controlled trial that aims to test the effectiveness of fire service--selected interventions in reducing serum PFAS levels. Study results will contribute to potential interventions that could be used to reduce serum PFAS levels in firefighters. Trial Registration: ClinicalTrials.gov NCT05869747; https://clinicaltrials.gov/study/NCT05869747 International Registered Report Identifier (IRRID): DERR1-10.2196/67120 ",
doi="10.2196/67120",
url="https://www.researchprotocols.org/2025/1/e67120"
}


@Article{info:doi/10.2196/70640,
author="Li Jung, Lu
and Chou, Chin Pei
and Wu, Yu-Hua",
title="Limited Moderating Effect of Podcast Listening on Work Stress and Emotional Exhaustion Among Nurses During the COVID-19 Pandemic: Cross-Sectional Study",
journal="JMIR Nursing",
year="2025",
month="Apr",
day="16",
volume="8",
pages="e70640",
keywords="work stress",
keywords="emotional exhaustion",
keywords="podcasts",
keywords="nurses",
keywords="COVID-19",
keywords="mental health",
abstract="Background: The COVID-19 pandemic placed unprecedented pressure on health care systems worldwide, significantly impacting frontline health care workers, especially nurses. These professionals faced considerable psychological stress from caring for patients with COVID-19 and the fear of spreading the virus to their families. Studies report that more than 60\% (132/220) of nurses experience anxiety, depression, and emotional exhaustion, which adversely affect their mental health and the quality of care they provide. Objective: This study aimed to investigate the relationship between work-related stress and emotional exhaustion among nurses and to assess whether listening to podcasts moderates this association. Methods: A cross-sectional online survey was conducted between March 1, 2023, and March 31, 2023. A total of 271 clinical nurses, aged 20 years to 65 years, were recruited for the study. Participants were divided into 2 groups: experimental group consisting of regular podcast listeners (n=173) and control group comprising nonlisteners (n=98). Ethical approval for this study was obtained from the local ethics committee (IRB number YGHIRB20230421B). Validated scales were used to measure work stress, emotional dissonance, and emotional exhaustion. Data analysis included descriptive statistics, independent t tests, and structural equation modeling to examine the relationships between variables. Results: No statistically significant differences were found between the experimental and control groups in terms of overall work stress (mean difference=--0.09, 95\% CI --0.31 to 0.13; P=.42) or emotional exhaustion (mean difference=0.07, 95\% CI --0.15 to 0.29; P=.53). Emotional dissonance emerged as a significant predictor of emotional exhaustion in both the experimental ($\beta$=0.476, P<.001) and control ($\beta$=0.321, P=.01) groups. Nurses reporting higher workloads had significantly higher emotional exhaustion levels (experimental group: $\beta$=0.302, P<.001; control group: $\beta$=0.327, P=.002). Podcast listening demonstrated only a slight, nonsignificant moderating effect. Conclusions: Although podcasts alone may not significantly reduce work stress or emotional exhaustion among nurses, there was a potential, albeit limited, moderating effect of podcasts on emotional well-being. They could serve as a supplementary tool for emotional support. However, broader and more comprehensive interventions are required to address the underlying causes of stress and emotional exhaustion in this population. More in-depth exploration and recommendations are possible by analyzing the content and patterns of listening. Further research is needed to examine the long-term benefits of integrating podcasts with other digital tools for holistic stress management in health care settings. ",
doi="10.2196/70640",
url="https://nursing.jmir.org/2025/1/e70640",
url="http://www.ncbi.nlm.nih.gov/pubmed/40159623"
}


@Article{info:doi/10.2196/59405,
author="Par{\'e}s-Salom{\'o}n, Iris
and Vaqu{\'e}-Crusellas, Cristina
and Coffey, Alan
and Loef, Bette
and Proper, I. Karin
and Se{\~n}{\'e}-Mir, M. Anna
and Puig-Ribera, Anna
and Dowd, P. Kieran
and Bort-Roig, Judit",
title="Development of Digital Strategies for Reducing Sedentary Behavior in a Hybrid Office Environment: Modified Delphi Study",
journal="JMIR Hum Factors",
year="2025",
month="Apr",
day="8",
volume="12",
pages="e59405",
keywords="sedentary behavior",
keywords="office work",
keywords="home office",
keywords="hybrid work",
keywords="technology",
keywords="Delphi",
abstract="Background: Hybrid work is the new modus operandi for many office workers, leading to more sedentary behavior than office-only working. Given the potential of digital interventions to reduce sedentary behavior and the current lack of studies evaluating these interventions for home office settings, it is crucial to develop digital interventions for such contexts involving all stakeholders. Objective: This study aimed to reach expert consensus on the most feasible work strategies and the most usable digital elements as a delivery method to reduce sedentary behavior in the home office context. Methods: A modified Delphi study including 3 survey rounds and focus groups was conducted to achieve consensus. The first Delphi round consisted of two 9-point Likert scales for assessing the feasibility of work strategies and the potential usefulness of digital elements to deliver the strategies. The work strategies were identified and selected from a scoping review, a systematic review, and 2 qualitative studies involving managers and employees. The median and mean absolute deviation from the median for each item are reported. The second round involved 2 ranking lists with the highly feasible strategies and highly useful digital elements based on round 1 responses to order the list according to experts' preferences. The weighted average ranking for each item was calculated to determine the most highly ranked work strategies and digital elements. The third round encompassed work strategies with a weight above the median from round 2 to be matched with the most useful digital elements to implement each strategy. In total, 4 focus groups were additionally conducted to gain a greater understanding of the findings from the Delphi phase. Focus groups were analyzed using the principles of reflexive thematic analysis. Results: A total of 27 international experts in the field of occupational health participated in the first round, with response rates of 86\% (25/29) and 66\% (19/29) in rounds 2 and 3, respectively, and 52\% (15/29) in the focus groups. Consensus was achieved on 18 work strategies and 16 digital elements. Feedback on activity progress and goal achievement; creating an action plan; and standing while reading, answering phone calls, or conducting videoconferences were the most feasible work strategies, whereas wrist-based activity trackers, a combination of media, and app interfaces in smartphones were the most useful digital elements. Moreover, experts highlighted the requirement of combining multiple levels of strategies, such as social support, physical environment, and individual strategies, to enhance their implementation and effectiveness in reducing sedentary behavior when working from home. Conclusions: This expert consensus provided a foundation for developing digital interventions for sedentary behavior in home office workers. Ongoing interventions should enable the evaluation of feasible strategies delivered via useful digital elements in home office or hybrid contexts. ",
doi="10.2196/59405",
url="https://humanfactors.jmir.org/2025/1/e59405",
url="http://www.ncbi.nlm.nih.gov/pubmed/40198908"
}


@Article{info:doi/10.2196/65000,
author="Shen, Yufei
and Choto Olivier, Alicia
and Yu, Han
and Ito-Masui, Asami
and Sakamoto, Ryota
and Shimaoka, Motomu
and Sano, Akane",
title="Personalized Physician-Assisted Sleep Advice for Shift Workers: Algorithm Development and Validation Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="1",
volume="9",
pages="e65000",
keywords="cognitive behavioral therapy",
keywords="CBT",
keywords="health care workers",
keywords="machine learning",
keywords="medical safety",
keywords="web-based intervention",
keywords="app-based intervention",
keywords="shift work",
keywords="shift work sleep disorders",
keywords="shift workers",
keywords="sleep disorder",
keywords="wearable sensors",
keywords="well-being",
abstract="Background: In the modern economy, shift work is prevalent in numerous occupations. However, it often disrupts workers' circadian rhythms and can result in shift work sleep disorder. Proper management of shift work sleep disorder involves comprehensive and patient-specific strategies, some of which are similar to cognitive behavioral therapy for insomnia. Objective: Our goal was to develop and evaluate machine learning algorithms that predict physicians' sleep advice using wearable and survey data. We developed a web- and app-based system to provide individualized sleep and behavior advice based on cognitive behavioral therapy for insomnia for shift workers. Methods: Data were collected for 5 weeks from shift workers (N=61) in the intensive care unit at 2 hospitals in Japan. The data comprised 3 modalities: Fitbit data, survey data, and sleep advice. After the first week of enrollment, physicians reviewed Fitbit and survey data to provide sleep advice and selected 1 to 5 messages from a list of 23 options. We handcrafted physiological and behavioral features from the raw data and identified clusters of participants with similar characteristics using hierarchical clustering. We explored 3 models (random forest, light gradient-boosting machine, and CatBoost) and 3 data-balancing approaches (no balancing, random oversampling, and synthetic minority oversampling technique) to predict selections for the 7 most frequent advice messages related to bedroom brightness, smartphone use, and nap and sleep duration. We tested our predictions under participant-dependent and participant-independent settings and analyzed the most important features for prediction using permutation importance and Shapley additive explanations. Results: We found that the clusters were distinguished by work shifts and behavioral patterns. For example, one cluster had days with low sleep duration and the lowest sleep quality when there was a day shift on the day before and a midnight shift on the current day. Our advice prediction models achieved a higher area under the precision-recall curve than the baseline in all settings. The performance differences were statistically significant (P<.001 for 13 tests and P=.003 for 1 test). Sensitivity ranged from 0.50 to 1.00, and specificity varied between 0.44 and 0.93 across all advice messages and dataset split settings. Feature importance analysis of our models found several important features that matched the corresponding advice messages sent. For instance, for message 7 (darken the bedroom when you go to bed), the models primarily examined the average brightness of the sleep environment to make predictions. Conclusions: Although our current system requires physician input, an accurate machine learning algorithm shows promise for automatic advice without compromising the trustworthiness of the selected recommendations. Despite its decent performance, the algorithm is currently limited to the 7 most popular messages. Further studies are needed to enable predictions for less frequent advice labels. ",
doi="10.2196/65000",
url="https://formative.jmir.org/2025/1/e65000"
}


@Article{info:doi/10.2196/66338,
author="Keefe, M. Janice
and McCloskey, Rose
and Hodgins, J. Marilyn
and McArthur, Caitlin
and MacKenzie, Adrian
and Weeks, E. Lori
and Estabrooks, A. Carole",
title="Examining Quality of Work Life in Atlantic Canadian Long-Term Care Homes: Protocol for a Cross-Sectional Survey Study",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="31",
volume="14",
pages="e66338",
keywords="residential long-term care",
keywords="care staff",
keywords="Atlantic Canada",
keywords="quality of work life",
keywords="work environment",
keywords="health and well-being",
abstract="Background: The Canadian long-term care (LTC) workforce cares for increasingly complex residents. With greater care needs come greater demands. Despite this, LTC staffing and resources are largely unchanged and underresearched over the last decade. The Atlantic provinces are home to the oldest population in Canada, indicating a high need for LTC. The health and well-being of the LTC workforce are critical components of care quality, yet only in Western Canada are such data routinely and systematically collected. Translating Research in Elder Care is a 2-decade research program studying the LTC work environment and has found strong links between the working conditions of LTC staff and resident outcomes. We draw upon their success to generate the evidence needed to understand, support, and manage the LTC workforce in Canada's four Atlantic provinces. Objective: This study aims (1) to assess the quality of work life among staff in LTC homes in Atlantic Canada; (2) to examine the effects of the work environment on the quality of work life; and (3) to build capacity for research in the LTC sector in Atlantic Canada among knowledge users, researchers, and trainees. The objective of this paper is to describe the approach needed to examine the quality of work life and health of care staff in LTC homes. Methods: Stratified random sampling will be used to recruit homes in Atlantic Canada. The sampling frame was designed to recruit 25\% of the LTC homes in each of the 4 provinces with proportional representation by size; ownership model; and, if applicable, region or language. Key outcome variables include measures of mental health and well-being, quality of work life, intention to leave, workplace context, and missed or rushed care. Primary data will be obtained through structured interviews with care aides and web-based surveys from registered nurses, licensed practical nurses, managers, and allied health providers. Eligible participants were from an LTC home with at least 25 residents, 90\% of whom were aged 65 years or older, and had worked in the home for at least 3 months. Multivariate analyses include regression analysis for explaining predictors of quality of work-life outcomes and multilevel modeling for more complex relationships of staff outcomes by provinces and LTC home characteristics. Results: Data collection and cleaning are complete as of October 2024 (N=2305). Care aides (n=1338), nurses (n=724), allied health providers (n=154), and managers (n=89) from 53 homes make up the sample. Data analysis is ongoing. Initially, individual reports will present descriptive data for each participating LTC home. Concurrent analysis is planned for publication in peer-reviewed journals. Conclusions: This peer-reviewed research protocol lays the foundation for a comprehensive analysis of the effects of the work environment on the quality of work life of LTC staff in Atlantic Canada. International Registered Report Identifier (IRRID): DERR1-10.2196/66338 ",
doi="10.2196/66338",
url="https://www.researchprotocols.org/2025/1/e66338"
}


@Article{info:doi/10.2196/60436,
author="M{\"a}nnist{\"o}, A. Siniriikka
and Pietil{\"a}inen, H. Kirsi
and Muotka, Joona
and Suojanen, Laura-Unnukka
and Lappalainen, Raimo
and Korpela, Riitta",
title="Coach-Assisted eHealth With Group or Individual Support for Employees With Obesity: Randomized Controlled Trial on Weight, Body Composition, and Health Metrics",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="12",
volume="27",
pages="e60436",
keywords="eHealth",
keywords="weight loss",
keywords="acceptance and commitment therapy",
keywords="weight-neutral",
keywords="Healthy Weight Coaching",
keywords="occupational health",
keywords="digital health",
keywords="body composition",
keywords="obesity",
keywords="psychobehavioral",
keywords="intervention",
keywords="health care",
keywords="metabolic health",
keywords="physiological change",
abstract="Background: Acceptance and commitment therapy provides a psychobehavioral framework feasible for digital and hybrid weight loss interventions. In face-to-face studies, group-based interventions yield more favorable outcomes than individual interventions, but the effect of the intervention form has not been studied in combination with eHealth. Objective: This study investigated whether a minimal, 3-session group or individual enhancement could provide additional benefits compared to an eHealth-only intervention when assessing weight, body composition, and laboratory metrics in a sample of occupational health patients with obesity. Methods: This study was a randomized controlled trial with a 12-month intervention, followed by a 12-month follow-up period without additional support (March 2021 to March 2023). Recruited from occupational health care for Finnish municipal employees, 111 working-age adults with a BMI of 30-40 kg/m2 were randomized to 1 of the 3 treatment arms: eHealth, eHealth+group, or eHealth+individual. All treatment arms received a web-administrated, coach-assisted eHealth program based on acceptance and commitment therapy, and additionally, the eHealth+group and eHealth+individual arms received 3 remotely facilitated group or individual meetings with their designated coach. The participants were assessed for weight, body composition, blood pressure, and laboratory measurements at 0-, 6-, 12-, and 24-month time points. Applying estimated means to decrease bias caused by dropouts, generalized estimating equations were used to study the differences between the 3 groups over time. Results: There were no between-group differences in primary measurements of weight change or categorical weight change. Secondary outcomes also did not show changes attributable to the intervention arm. Across the entire sample, the total weight loss was 1.5\% during the intervention, with 18\% (20/111) of the participants attaining a ?5\% weight loss. Sustained at follow-up, waist circumference decreased, and high-density lipoprotein cholesterol increased slightly. The participants completed, on average, 58.6\% of the eHealth program. Conclusions: There were no differences in weight or other somatic health variables between the eHealth arm and intervention combining eHealth with minimal group or individual enhancement. Despite a modest overall weight loss, the intervention shows promise in improving body composition and metabolic health. Moving forward, further research is needed to determine if there is a threshold where face-to-face meetings provide additional benefits in hybrid interventions. Moreover, there is a need to explore for whom and under what conditions eHealth and hybrid models may be most effective. Trial Registration: ClinicalTrials.gov NCT04785586; https://clinicaltrials.gov/study/NCT04785586 ",
doi="10.2196/60436",
url="https://www.jmir.org/2025/1/e60436",
url="http://www.ncbi.nlm.nih.gov/pubmed/40073400"
}


@Article{info:doi/10.2196/64892,
author="Bibbo, Daniele
and Corvini, Giovanni
and Schmid, Maurizio
and Ranaldi, Simone
and Conforto, Silvia",
title="The Impact of Human-Robot Collaboration Levels on Postural Stability During Working Tasks Performed While Standing: Experimental Study",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="27",
volume="12",
pages="e64892",
keywords="human-robot collaboration",
keywords="cobot assistance",
keywords="postural control",
keywords="biomechanical risk",
keywords="ergonomics",
keywords="collaborative robot",
abstract="Background: The integration of collaborative robots (cobots) in industrial settings has the potential to enhance worker safety and efficiency by improving postural control and reducing biomechanical risk. Understanding the specific impacts of varying levels of human-robot collaboration on these factors is crucial for optimizing cobot use. Objective: This study aims to investigate the biomechanical effects of different levels of human-robot collaboration on postural stability and control during simulated working tasks. Methods: A total of 14 participants performed simulated cashier working activities under 4 different collaboration modalities, with increasing levels of cobot assistance: full (Fu), half robot touch (HRT), half robot (HRb), and full robot (FRb). Center of pressure trajectories were extracted from 2 force plates' data to calculate 4 posturography parameters---mean distance (MDIST), mean velocity (MVELO), 95\% confidence ellipse area (AREA-CE), and sway area (AREA-SW)---which were analyzed to assess the impact of cobot intervention on postural control. Results: Nonparametric tests showed significance in the effect of the collaboration modalities on the 4 analyzed parameters. Post hoc tests revealed that FRb modality led to the greatest enhancement in postural stability, with a reduction in MDIST (4.2, SD 1.3 cm in Fu vs 1.6, SD 0.5 cm in FRb) and MVELO (16.3, SD 5.2 cm/s in Fu vs 7.9, SD 1.1 cm/s in FRb). AREA-CE and AREA-SW also decreased significantly with higher levels of cobot assistance (AREA-CE: 134, SD 91 cm{\texttwosuperior} in Fu vs 22, SD 12 cm{\texttwosuperior} in FRb; AREA-SW: 16.2, SD 8.4 cm{\texttwosuperior}/s in Fu vs 4.0, SD 1.6 cm{\texttwosuperior}/s in FRb). Complete assistance of the cobot significantly reduced interindividual variability of all center of pressure parameters. In FRb modality, as compared with all other conditions, removing the weight of the object during loading or unloading phases caused a significant decrease in all parameter values. Conclusions: Increased cobot assistance significantly enhances postural stability and reduces biomechanical load on workers during simulated tasks. Full assistance from cobots, in particular, minimizes postural displacements, indicating more consistent postural control improvements across individuals. However, high levels of cobot intervention also reduced the natural variation in how people balanced themselves. This could potentially lead to discomfort in the long run. Midlevel cobot assistance modalities can thus be considered as a good compromise in reducing biomechanical risks associated with postural stability at the same time granting a satisfactory level of user control. ",
doi="10.2196/64892",
url="https://humanfactors.jmir.org/2025/1/e64892"
}


@Article{info:doi/10.2196/64111,
author="Hore-Lacy, Fiona
and Dimitriadis, Christina
and Hoy, F. Ryan
and Jimenez-Martin, Javier
and Sim, R. Malcolm
and Fisher, Jane
and Glass, C. Deborah
and Walker-Bone, Karen",
title="Screening Workers for Occupational Exposure to Respirable Crystalline Silica: Development and Usability of an Electronic Data Capture Tool",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="24",
volume="12",
pages="e64111",
keywords="silicosis",
keywords="occupational history",
keywords="electronic data capture tool (EDCT)",
keywords="REDCap",
keywords="occupational respiratory screening",
keywords="occupational hazard",
keywords="exposure",
keywords="silica",
keywords="fibrotic lung disease",
keywords="lung disease",
keywords="respirable crystalline silica",
keywords="mining",
keywords="construction",
keywords="workers",
keywords="occupational lung disease",
keywords="occupational",
keywords="Australia",
keywords="screening",
abstract="Background: Cases of the occupational lung disease silicosis have been identified in workers processing artificial stone in the stone benchtop industry (SBI). In the Australian state of Victoria, the Regulator commissioned a screening program for all workers in this industry. Objective: To facilitate systematic data collection, including high-quality exposure assessment, an electronic data capture tool (EDCT) was developed. Methods: A multidisciplinary team developed an EDCT using Research Electronic Data Capture (REDCap; Vanderbilt University). The needs of the EDCT were (1) data entry by multiple clinicians and the workers attending for screening and (2) systematic collection of data for clinical and research purposes. The comprehensibility and utility of the tool were investigated with a sample of workers, and the EDCT was subsequently refined. Results: The EDCT was used in clinical practice, with capacity for data extraction for research. Testing of comprehension and utility was undertaken with 15 workers, and the refined version of the Occupational Silica Exposure Assessment Tool (OSEAT) was subsequently developed. Conclusions: The refined OSEAT has been determined to be comprehensible to workers and capable of collecting exposure data suitable for assessment of risk of silicosis. It was developed for workers in the SBI in Australia and is adaptable, including translation into other languages. It can also be modified for SBI workers in other countries and for use by workers from other industries (mining, construction) at risk of silica exposure, including in lower-income settings. ",
doi="10.2196/64111",
url="https://humanfactors.jmir.org/2025/1/e64111"
}


@Article{info:doi/10.2196/51271,
author="De Croon, Robin
and Segovia-Lizano, Daniela
and Finglas, Paul
and Vanden Abeele, Vero
and Verbert, Katrien",
title="An Explanation Interface for Healthy Food Recommendations in a Real-Life Workplace Deployment: User-Centered Design Study",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Feb",
day="11",
volume="13",
pages="e51271",
keywords="food recommender systems",
keywords="personalized nutrition",
keywords="healthy eating",
keywords="human-computer interaction",
keywords="real-life deployment",
keywords="food catering",
keywords="meal recommendations",
keywords="nutritional profile",
keywords="transparency",
abstract="Background: Despite widespread awareness of healthy eating principles, many individuals struggle to translate this knowledge into consistent, sustainable dietary change. Food recommender systems, increasingly used in various settings, offer the potential for personalized guidance and behavior change support. However, traditional approaches may prioritize user preferences or popularity metrics without sufficiently considering long-term nutritional goals. This can inadvertently reinforce unhealthy eating patterns. Emerging research suggests that incorporating explanations into recommender systems can increase transparency, promote informed decision-making, and potentially influence food choices. Yet, the effectiveness of explanations in promoting healthy choices within complex, real-world food environments remain largely unexplored. Objective: This study aims to investigate the design, implementation, and preliminary evaluation of a food recommender system that integrates explanations in a real-world food catering application. We seek to understand how such a system can promote healthy choices while addressing the inherent tensions between user control, meal variety, and the need for nutritionally sound recommendations. Specifically, our objectives are to (1) identify and prioritize key design considerations for food recommenders that balance personalization, nutritional guidance, and user experience; and (2) conduct a proof-of-principle study in a real-life setting to assess the system's effect on user understanding, trust, and potentially on dietary choices. Methods: An iterative, user-centered design process guided the development and refinement of the system across 4 phases: (Phase 0) an exploratory qualitative study (N=26) to understand stakeholder needs and initial system impressions, (Phases 1 and 2) rapid prototyping in real-life deployments (N=45 and N=16, respectively) to iteratively improve usability and features, and (Phase 3) a proof-of-principle study with employees (N=136) to evaluate a set of design goals. We collected a mix of data, including usage logs, pre- and post-study questionnaires, in-app feedback, and a pre- and post--Food Frequency Questionnaire to establish nutritional profiles. Results: Although we experienced a high drop-out (77\% after 7 weeks), motivated and remaining participants valued personalization features, particularly the ability to configure allergies and lifestyle preferences. Explanations increased understanding of recommendations and created a sense of control, even when preferences and healthy options did not fully align. However, a mismatch persisted between individual preferences and nutritionally optimal recommendations. This highlights the design challenge of balancing user control, meal variety, and the promotion of healthy eating. Conclusions: Integrating explanations into personalized food recommender systems might be promising for supporting healthier food choices and creating a more informed understanding of dietary patterns. Our findings could highlight the importance of balancing user control with both the practical limitations of food service settings and the need for nutritionally sound recommendations. While fully resolving the tension between immediate preferences and long-term health goals is an ongoing challenge, explanations can play a crucial role in promoting more conscious decision-making. ",
doi="10.2196/51271",
url="https://mhealth.jmir.org/2025/1/e51271"
}


@Article{info:doi/10.2196/58528,
author="Lee, Man-Sin Maggie
and Yeoh, Eng-kiong
and Wong, Lai-Yi Eliza
and Bai, Xue
and Yeung, Chun-Yiu Nelson
and French, Catherine
and Taddese, Henock",
title="Perceptions and Experiences of Caregiver-Employees, Employers, and Health Care Professionals With Caregiver-Friendly Workplace Policy in Hong Kong: Thematic Analysis",
journal="Interact J Med Res",
year="2025",
month="Feb",
day="10",
volume="14",
pages="e58528",
keywords="caregiver employees",
keywords="workplace",
keywords="discrimination",
keywords="dual roles",
keywords="caregiver burden",
abstract="Background: Caregiver-employees (CEs) for older adults experience a high burden to fulfill their dual roles. Caregiver-friendly workplace policy (CFWP) has been used in many countries to balance employment and caregiving duties, but it is a relatively new concept in Hong Kong. Objective: This study explored the views and experiences of CEs, employers, and health care professionals regarding CFWP (specifically for older adult caregivers) in Hong Kong. Methods: This study explored the CFWP-related views and experiences in Hong Kong using 15 in-depth interviews with purposively sampled CEs for older adults, employers, and health care professionals. Results: Two context-related themes (``lacking leadership'' and ``unfavorable culture'') were identified with thematic analysis. They explain the absence of CFWP in Hong Kong due to the lack of governmental and organizational leadership, and the additional burden experienced by CEs because of the working culture that underpins work-life separation, overprizing business interest, and unsympathetic corporate attitude. Implicit voice theory was applicable in explaining CEs' nondisclosure about their status at work due to potential risks. In addition, the two facilitation-related themes (``role struggle'' and ``inadequate support'') identified in this study exhibit how the dual role had positive and negative spillover effects on each other and the inadequacy of social welfare and health care support systems. Conclusions: We strongly recommend exploring and adopting potential CFWP in Hong Kong, considering the complexity of factors identified in this study. ",
doi="10.2196/58528",
url="https://www.i-jmr.org/2025/1/e58528"
}


@Article{info:doi/10.2196/64817,
author="Dunleavy, Kim
and Radunovich, Liss Heidi
and Beneciuk, M. Jason
and Hu, Boyi
and Yang, Yang
and Blythe, McCormick Janeen
and Gurka, K. Kelly",
title="Self-Management Strategies for Low Back Pain Among Horticulture Workers: Protocol for a Type II Hybrid Effectiveness-Implementation Study",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="28",
volume="14",
pages="e64817",
keywords="low back pain",
keywords="self-management",
keywords="implementation",
keywords="horticulture workers",
keywords="video training",
keywords="video feedback",
keywords="text message reminders",
keywords="agriculture",
keywords="ergonomic",
keywords="nonpharmacological",
abstract="Background: Low back pain (LBP) is highly prevalent and disabling, especially in agriculture sectors. However, there is a gap in LBP prevention and intervention studies in these physically demanding occupations, and to date, no studies have focused on horticulture workers. Given the challenges of implementing interventions for those working in small businesses, self-management offers an attractive and feasible option to address work-related risk factors and manage LBP. Objective: This study will (1) investigate the effectiveness of self-management strategies for nursery and landscape workers by comparing within-subject control and intervention periods and (2) determine if adoption and effectiveness differs between participants randomly assigned to review self-management videos only and those who also receive multimodal implementation support. We will also identify contextual factors impacting effectiveness and implementation. Methods: A pragmatic, mixed methods, hybrid effectiveness and implementation design will be used to compare back pain with work tasks, disability, medication and substance use, and psychological factors between a baseline control and intervention periods. We aim to recruit 122 English- and Spanish-speaking horticulture workers with back pain, 30 supervisors, and 12 focus group participants. Participants will review short video modules designed to increase awareness of opioid risk and introduce self-management and ergonomic choices and use 1 self-management and 1 ergonomic strategy for 10 weeks. They will be randomly assigned to 2 implementation groups: video modules only or video + multimodal personalized support (checklist guidance, review of video feedback for ergonomic problem-solving, and text message reminders). Questionnaires will be administered at 3-month time points: baseline, pre- and postintervention, and at 3 and 6 months. Qualitative analysis of field notes, open-ended comments, and focus groups will expand understanding of results with comprehensive documentation of the context, barriers and facilitators, and reasons for adoption. Results: The project was funded on September 29, 2023 (Centers for Disease Control and Prevention National Institute of Occupational Health and Safety, CDC NIOSH; U54OH011230-07S1), as a core research grant for the Southeast Coastal Center for Agricultural Health and Safety. The design, creation, and editing of English and Spanish videos was completed in June 2024 after comprehensive formative evaluation. Enrollment began in June 2024 with anticipated completion in 2027. Conclusions: We hypothesize that both self-management interventions will result in reductions in work task pain and disability and that the video enhanced with multimodal personalized support will result in greater reductions than the video alone. If self-management is effective, mitigating pain positively impacts quality of life, productivity, and retention, while increasing the use of nonpharmacological alternatives to opioids addresses an important public health issue. Implementation aims will help inform reasons for results, barriers and facilitators, and potential for similar interventions in these and similar industries with physically challenging outdoor work. Trial Registration: ClinicalTrials.gov NCT06153199; http://clinicaltrials.gov/study/NCT06153199 International Registered Report Identifier (IRRID): DERR1-10.2196/64817 ",
doi="10.2196/64817",
url="https://www.researchprotocols.org/2025/1/e64817"
}


@Article{info:doi/10.2196/59845,
author="Sood, Akshay
and ``Cotton'' Jarrell, William
and Shore, W. Xin
and Sosa, Nestor
and Parada, Alisha
and Edwardson, Nicholas
and Yingling, V. Alexandra
and Amirkabirian, Teah
and Cheng, Qiuying
and Hurwitz, Ivy
and Cook, S. Linda
and Leng, Shuguang
and Myers, B. Orrin
and Perkins, J. Douglas",
title="Effectiveness of Frequent Point-of-Care Molecular COVID-19 Surveillance in a Rural Workplace: Nonrandomized Controlled Clinical Trial Among Miners",
journal="JMIR Public Health Surveill",
year="2025",
month="Jan",
day="27",
volume="11",
pages="e59845",
keywords="point-of-care",
keywords="seroprevalence",
keywords="SARS-CoV-2",
keywords="coronavirus",
keywords="COVID-19",
keywords="surveillance",
keywords="rural workplace",
keywords="miners",
keywords="infectious disease",
keywords="pandemic",
keywords="antigen testing",
keywords="midnasal swabs",
keywords="public health",
abstract="Background: Numerous studies have assessed the risk of SARS-CoV-2 exposure and infection among health care workers during the pandemic. However, far fewer studies have investigated the impact of SARS-CoV-2 on essential workers in other sectors. Moreover, guidance for maintaining a safely operating workplace in sectors outside of health care remains limited. Workplace surveillance has been recommended by the Centers for Disease Control and Prevention, but few studies have examined the feasibility or effectiveness of this approach. Objective: The objective of this study was to investigate the feasibility and effectiveness of using frequent point-of-care molecular workplace surveillance as an intervention strategy to prevent the spread of SARS-CoV-2 at essential rural workplaces (mining sites) where physical distancing, remote work, and flexible schedules are not possible. Methods: In this nonrandomized controlled clinical trial conducted from February 2021, to March 2022, 169 miners in New Mexico (intervention cohort) and 61 miners in Wyoming (control cohort) were enrolled. Investigators performed point-of-care rapid antigen testing on midnasal swabs (NSs) self-collected by intervention miners. Our first outcome was the intervention acceptance rate in the intervention cohort. Our second outcome was the rate of cumulative postbaseline seropositivity to SARS-CoV-2 nucleocapsid protein, which was analyzed in the intervention cohort and compared to the control cohort between baseline and 12 months. The diagnostic accuracy of detecting SARS-CoV-2 using rapid antigen testing on NSs was compared to laboratory-based reverse transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs (NPSs) in a subset of 68 samples. Results: Our intervention had a mean acceptance rate of 96.4\% (11,413/11,842). The intervention miners exhibited a lower cumulative postbaseline incident seropositivity at 12 months compared to control miners (14/97, 14\% vs 17/45, 38\%; P=.002). Analysis of SARS-CoV-2 antigen detection in self-administered NSs revealed 100\% sensitivity and specificity compared to laboratory-based RT-PCR testing on NPSs. Conclusions: Our findings establish frequent point-of-care molecular workplace COVID-19 surveillance as a feasible option for keeping essential rural workplaces open and preventing SARS-CoV-2 spread. These findings extend beyond this study, providing valuable insights for designing interventions to maintain employees' safety at other essential workplaces during an infectious disease outbreak. Trial Registration: ClinicalTrials.gov NCT04977050; https://clinicaltrials.gov/study/NCT04977050 ",
doi="10.2196/59845",
url="https://publichealth.jmir.org/2025/1/e59845"
}


@Article{info:doi/10.2196/59606,
author="Dini, Guglielmo
and Curti, Stefania
and Rahmani, Alborz
and Durando, Paolo
and Mattioli, Stefano",
title="Occupational Infections Among Workers in Europe: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="24",
volume="14",
pages="e59606",
keywords="infection",
keywords="work-related",
keywords="biological hazard",
keywords="narrative synthesis",
keywords="Europe",
keywords="occupational infection",
keywords="worker",
keywords="scoping review",
keywords="infectious",
keywords="prevention and control",
keywords="occupational health",
keywords="epidemiology",
keywords="burden of disease",
keywords="phenomenon",
abstract="Background: Workers may be exposed to different infectious agents, putting them at risk of developing occupational diseases. This can occur in many ways, through deliberate use of speci?c microorganisms or through potential exposure from close contact with biological material. Infection prevention and control measures against biohazards can reduce the risk of infection among workers. During the last few decades, an increasing proportion of workers in Europe have been exposed to infectious biological agents in their workplace. Knowledge gaps on this topic in Europe have limited our understanding of the overall phenomenon in occupational settings. Objective: This study aims to understand the extent and type of evidence on the epidemiology of occupational or work-related infections caused by bacterial, viral, fungal, and parasitical agents in European countries, the factors affecting their occurrence among workers, and the burden of disease among workers due to occupational risk. Methods: The review will be conducted following the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. This review will consider studies that include data on the epidemiology of occupational infections, risk factors and determinants, and burden of disease among workers employed in specific occupational sectors in European countries in the period 2010-2023. The search will include MEDLINE, Web of Science, and Scopus databases. Independent reviewers (including GD, SC, AR, PD, and SM) will screen the titles, abstracts, and full texts of the selected studies. Data extraction will be performed using a tool developed by the researchers. The data will be mapped and analyzed according to the type of extracted data. Results: The literature search through different scientific databases started in April 2024 and is expected to be completed by December 2024. The findings will be extracted using an ad hoc data extraction tool, and relevant results will be presented in narrative and tabular form. Conclusions: This scoping review aims to provide rigorous evidence to fill the knowledge gap in the epidemiology of occupational or work-related infections in European countries, the factors affecting their occurrence, and the burden of disease in different professional settings. Such findings could improve the understanding of this complex occupational phenomenon in the European context, enabling more accurate and up-to-date surveillance of infections incurred in the workplace. International Registered Report Identifier (IRRID): PRR1-10.2196/59606 ",
doi="10.2196/59606",
url="https://www.researchprotocols.org/2025/1/e59606"
}


@Article{info:doi/10.2196/50852,
author="Bienefeld, Nadine
and Keller, Emanuela
and Grote, Gudela",
title="AI Interventions to Alleviate Healthcare Shortages and Enhance Work Conditions in Critical Care: Qualitative Analysis",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="13",
volume="27",
pages="e50852",
keywords="artificial intelligence",
keywords="AI",
keywords="work design",
keywords="sociotechnical system",
keywords="work",
keywords="job",
keywords="occupational health",
keywords="sociotechnical",
keywords="new work",
keywords="future of work",
keywords="satisfaction",
keywords="health care professionals",
keywords="intensive care",
keywords="ICU",
keywords="stress mitigation",
keywords="worker",
keywords="employee",
keywords="stress",
keywords="health care professional",
keywords="overburdened",
keywords="burden",
keywords="burnout",
keywords="autonomy",
keywords="competence",
keywords="flexible",
keywords="task",
keywords="workplace",
keywords="hospital",
abstract="Background: The escalating global scarcity of skilled health care professionals is a critical concern, further exacerbated by rising stress levels and clinician burnout rates. Artificial intelligence (AI) has surfaced as a potential resource to alleviate these challenges. Nevertheless, it is not taken for granted that AI will inevitably augment human performance, as ill-designed systems may inadvertently impose new burdens on health care workers, and implementation may be challenging. An in-depth understanding of how AI can effectively enhance rather than impair work conditions is therefore needed. Objective: This research investigates the efficacy of AI in alleviating stress and enriching work conditions, using intensive care units (ICUs) as a case study. Through a sociotechnical system lens, we delineate how AI systems, tasks, and responsibilities of ICU nurses and physicians can be co-designed to foster motivating, resilient, and health-promoting work. Methods: We use the sociotechnical system framework COMPASS (Complementary Analysis of Sociotechnical Systems) to assess 5 job characteristics: autonomy, skill diversity, flexibility, problem-solving opportunities, and task variety. The qualitative analysis is underpinned by extensive workplace observation in 6 ICUs (approximately 559 nurses and physicians), structured interviews with work unit leaders (n=12), and a comparative analysis of data science experts' and clinicians' evaluation of the optimal levels of human-AI teaming. Results: The results indicate that AI holds the potential to positively impact work conditions for ICU nurses and physicians in four key areas. First, autonomy is vital for stress reduction, motivation, and performance improvement. AI systems that ensure transparency, predictability, and human control can reinforce or amplify autonomy. Second, AI can encourage skill diversity and competence development, thus empowering clinicians to broaden their skills, increase the polyvalence of tasks across professional boundaries, and improve interprofessional cooperation. However, careful consideration is required to avoid the deskilling of experienced professionals. Third, AI automation can expand flexibility by relieving clinicians from administrative duties, thereby concentrating their efforts on patient care. Remote monitoring and improved scheduling can help integrate work with other life domains. Fourth, while AI may reduce problem-solving opportunities in certain areas, it can open new pathways, particularly for nurses. Finally, task identity and variety are essential job characteristics for intrinsic motivation and worker engagement but could be compromised depending on how AI tools are designed and implemented. Conclusions: This study demonstrates AI's capacity to mitigate stress and improve work conditions for ICU nurses and physicians, thereby contributing to resolving health care staffing shortages. AI solutions that are thoughtfully designed in line with the principles for good work design can enhance intrinsic motivation, learning, and worker well-being, thus providing strategic value for hospital management, policy makers, and health care professionals alike. ",
doi="10.2196/50852",
url="https://www.jmir.org/2025/1/e50852"
}


@Article{info:doi/10.2196/57604,
author="Akksilp, Katika
and Rouyard, Thomas
and Isaranuwatchai, Wanrudee
and Nakamura, Ryota
and M{\"u}ller-Riemenschneider, Falk
and Teerawattananon, Yot
and Chen, Cynthia",
title="The Physical Activity at Work (PAW) Program in Thai Office Workers: Mixed Methods Process Evaluation Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="2",
volume="9",
pages="e57604",
keywords="process evaluation",
keywords="sedentary behavior",
keywords="physical activity",
keywords="workplace",
keywords="movement breaks",
abstract="Background: An increasing number of multicomponent workplace interventions are being developed to reduce sedentary time and promote physical activity among office workers. The Physical Activity at Work (PAW) trial was one of these interventions, but it yielded an inconclusive effect on sedentary time after 6 months, with a low uptake of movement breaks, the main intervention component. Objective: This study investigates the factors contributing to the outcomes of the PAW cluster randomized trial. Methods: Following the Medical Research Council's guidance for process evaluation of complex interventions, we used a mixed methods study design to evaluate the PAW study's recruitment and context (how job nature and cluster recruitment affected movement break participation), implementation (dose and fidelity), and mechanisms of impact (assessing how intervention components affected movement break participation and identifying the facilitators and barriers to participation in the movement breaks). Data from accelerometers, pedometers, questionnaires, on-site monitoring, and focus group discussions were used for the evaluation. Linear mixed effects models were used to analyze the effects of different intervention components on the movement breaks. Subsequently, qualitative analysis of the focus group discussions provided additional insights into the relationship between the intervention components. Results: The participation in movement breaks declined after the third week, averaging 12.7 sessions (SD 4.94) per participant per week for the first 3 weeks, and continuing to decrease throughout the intervention. On-site monitoring confirmed high implementation fidelity. Analysis of Fitbit data revealed that each additional movement break was associated with a reduction of 6.20 (95\% CI 6.99-5.41) minutes in sedentary time and an increase of 245 (95\% CI 222-267) steps. Regarding the mechanisms of impact, clusters with higher baseline sedentary time demonstrated greater participation in movement breaks, while those with frequent out-of-office duties showed minimal engagement. Moreover, clusters with enthusiastic and encouraging movement break leaders were associated with a 24.1\% (95\% CI 8.88\%-39.4\%) increase in participation. Environmental and organizational support components using posters and leaders' messages were ineffective, showing no significant change in percentage participation in movement breaks (4.49\%, 95\% CI --0.49\% to 9.47\% and 1.82\%, 95\% CI --2.25\% to 5.9\%, respectively). Barriers such as high workloads and meetings further hindered participation, while the facilitators included participants' motivation to feel active and the perceived health benefits from movement breaks. Conclusions: Despite high fidelity, the PAW trial did not significantly reduce sedentary time, with limited uptake of movement breaks due to context-related challenges, ineffective environmental support, and high workloads during the COVID-19 pandemic. ",
doi="10.2196/57604",
url="https://formative.jmir.org/2025/1/e57604"
}


@Article{info:doi/10.2196/59927,
author="Xie, Yao
and Fadahunsi, Philip Kayode
and Flynn, Paul
and Taylor-Robinson, Simon
and Gallagher, Joseph
and Cullen, Walter
and O'Donoghue, John",
title="Barriers and Facilitators of International Health Care Students' Well-Being in Higher Education: Protocol for a Systematic Integrative Review",
journal="JMIR Res Protoc",
year="2024",
month="Dec",
day="11",
volume="13",
pages="e59927",
keywords="integrative review",
keywords="higher education",
keywords="international students",
keywords="educational migrants",
keywords="barriers",
keywords="facilitators",
keywords="well-being",
keywords="mixed methods synthesis",
keywords="health care students",
keywords="health care education",
abstract="Background: International health care students encounter unique hurdles as they pursue education in foreign countries. These challenges, stemming from adjustment to new cultural environments and stressful academic programs, significantly impact their well-being. Understanding the barriers and facilitators experienced by international health care students is crucial for ensuring their successful integration into academic and professional spheres. Most existing reviews focus on specific populations or disciplines, thus limiting their generalizability. Objective: This systematic integrative review aims to provide a comprehensive understanding of barriers and facilitators of international health care students' well-being in higher education. Methods: The protocol follows the Joanna Briggs Institute's guidance for a mixed methods systematic review. The main information sources will include PubMed, Scopus, Web of Science, and EBSCOhost, supplemented with manual reference search and citation tracking using Google Scholar. The study selection will be done independently by 2 reviewers based on predetermined eligibility criteria. The study population will consist of international higher education students enrolled in human health--related disciplines including medicine, pharmacy, nursing, and allied health care fields. Qualitative and quantitative data relating to barriers and facilitators of international health care students' well-being will be extracted using a customized data extraction template in Covidence review management software. Quantitative data will be ``qualitized'' and integrated with qualitative data using a convergent integrated approach, as described in the Joanna Briggs Institute's guidance. The integrated data will then be synthesized using a thematic analysis approach to provide a comprehensive understanding of barriers and facilitators of international health care students' well-being. Results: The initial literature search yielded 2408 papers from the selected databases. The findings of this review will be presented in a narrative format, supported by visualizations such as tables and diagrams. The review is expected to be completed by December 2024. Conclusions: This systematic integrative review will identify barriers and facilitators of international health care students' well-being in higher education. The findings could inform the development of targeted interventions and support initiatives in higher education institutions globally, with the ultimate goal of enhancing the well-being as well as the academic and professional success of international health care students. Trial Registration: PROSPERO CRD42024372785; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42024372785 International Registered Report Identifier (IRRID): PRR1-10.2196/59927 ",
doi="10.2196/59927",
url="https://www.researchprotocols.org/2024/1/e59927"
}


@Article{info:doi/10.2196/50754,
author="Guo, Xinyue
and Gong, Shaoqing
and Chen, Ying
and Hou, Xiaohui
and Sun, Tong
and Wen, Jianqiang
and Wang, Zhiyao
and He, Jingyang
and Sun, Xuezhu
and Wang, Sufang
and Chen, Zhixin
and Feng, Xue
and Tian, Xiangyang",
title="Weight and Lifestyle Behavior Changes in Chinese Health Care Workers During the COVID-19 Pandemic: 3-Year Retrospective Survey",
journal="Interact J Med Res",
year="2024",
month="Dec",
day="10",
volume="13",
pages="e50754",
keywords="COVID-19",
keywords="healthcare workers",
keywords="lifestyle behavior",
keywords="overweight",
keywords="obesity",
keywords="physical activity",
keywords="mental health",
keywords="stress",
keywords="anxiety,depression",
keywords="pandemic",
abstract="Background: Health care workers (HCWs) played a key role in preventing and controlling COVID-19. Higher infection risks and intensive work led to occupational burnout for many HCWs, which may affect their lifestyle behaviors and weight. Objective: This study aimed to assess HCWs' self-rated health status, overweight and obesity rates, lifestyle behaviors, and psychoemotional changes from 2019 to 2022 across China and to analyze the factors associated with changes from underweight or normal weight in 2019 to overweight or obese in 2022. Methods: In this retrospective study, 100 health care institutions were randomly selected from 5 provinces or regions in China. All HCWs who worked in the institutions for at ?3 years were invited to complete the electronic questionnaire and participate in the online survey from August 1, 2022, to August 31, 2022. Collected data included changes in lifestyle behaviors (dietary habits, physical activity, sleep quality, smoking, alcohol consumption), psychoemotional conditions (persistent stress or recurrent anxiety or depressed mood), health status, and chronic disease control from December 2019 to August 2022. Height and weight in 2019 and 2022 were retrieved from annual physical examination records. Overweight and obesity were defined as 24.0?kg/m2?BMI<28.0?kg/m2 (overweight) and BMI?28.0?kg/m2 (obesity). Chi square tests and ANOVAs were used to assess the associations between groups. Logistic regression models were used to analyze the factors associated with HCWs becoming overweight or obese from 2019 to 2022. Results: The questionnaire was submitted by 23,234 HCWs. Of the underweight or normal weight HCWs in 2019, 12.67\% (1486/23,234) became overweight or obese in 2022; this change was associated with the following factors: 34-43 years old (OR 0.843, 95\% CI 0.740-0.960), 44-53 years old (OR 0.738, 95\% CI 0.635-0.960), and 54-63 years old (OR 0.503, 95\% CI 0.368-0.685; reference: 24-33 years old), reduction in or never or rarely engaging in physical activity (OR 1.201, 95\% CI 1.055-1.368; reference: increase in physical activity; P=.006), increased appetite (OR 2.043, 95\% CI 1.788-2.034; reference: reduction or no change in appetite; P<.001). From 2019 to 2022, 51.29\% (11,917/23,234) of the respondents experienced increased persistent stress or recurrent anxiety or depressed mood; 44.38\% (10,311/23,234) stayed up late more often. Increased persistent stress or recurrent anxiety or depressed mood was associated with physical activity (OR 0.421, 95\% CI 0.398-0.447; P<.001) and appetite (OR 1.601, 95\% CI 1.483-1.728; P<.001). Conclusions: The pandemic was associated with overweight and obesity for HCWs due to changes in lifestyle behaviors, especially reduced physical activity and increased appetite related to increased persistent stress or recurrent anxiety or depressed mood caused by excessive workload. An integrated approach is needed to address overweight and obesity and lifestyle changes among HCWs by releasing negative psychoemotional conditions through workload reduction in future stressful events. ",
doi="10.2196/50754",
url="https://www.i-jmr.org/2024/1/e50754"
}


@Article{info:doi/10.2196/57851,
author="Zhou, Shanyu
and Huang, Yongshun
and Chen, Lin
and Wen, Xianzhong
and Wang, Shu
and Huang, Lang
and Li, Xudong",
title="Epidemiological Characteristics and Spatiotemporal Analysis of Occupational Noise--Induced Deafness From 2006 to 2022 in Guangdong, China: Surveillance Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="29",
volume="10",
pages="e57851",
keywords="occupational noise-induced deafness",
keywords="epidemiological characteristics",
keywords="joinpoint regression",
keywords="spatial autocorrelation",
keywords="Guangdong",
keywords="noise-induced",
keywords="deafness",
keywords="hearing loss",
keywords="hearing impairment",
keywords="occupational noise",
keywords="noise",
keywords="ONID",
keywords="China",
keywords="epidemiology",
keywords="spatiotemporal analysis",
keywords="comprehensive analysis",
keywords="occupational diseases",
keywords="policy formulation",
keywords="health resource",
keywords="surveillance",
keywords="Moran's I",
keywords="spatial",
keywords="clustering",
keywords="public health",
keywords="teleaudiology",
keywords="audiology",
abstract="Background: Occupational noise--induced deafness (ONID) has replaced occupational poisoning as the second most common occupational disease in China since 2015. However, there is a limited number of articles on epidemiological characteristics of legally diagnosed ONID. Objective: We conducted a comprehensive analysis of the epidemiological and spatiotemporal characteristics of ONID in Guangdong Province from 2006 to 2022, with the aim of providing a scientific foundation for policy formulation and health resource allocation. Methods: Surveillance data of ONID cases in Guangdong Province from 2006 to 2022 were obtained from the ``Occupational Diseases and Health Hazard Factors Monitoring Information System.'' Joinpoint regression analysis was applied to assess the long-term trends in cases of ONID from 2006 to 2022. Global spatial autocorrelation analysis was performed to measure the overall degree of similarity of the attribute values of spatially adjacent or neighboring regional units. The local indicators of spatial autocorrelation (LISA) plots were then used to identify the local clusters of ONID in Guangdong. Results: There were 3761 ONID cases in Guangdong Province from 2006 to 2022, showing a significantly increased trend in cases across the entire study period (average annual percentage change 21.9, 95\% CI 18.7-35.1). The Moran's I values for the period of 2006 to 2022 ranged from 0.202 to 0.649 (all P<.001), indicating a positive spatial correlation of ONID across regions each year in Guangdong Province. A total of 15 high-high clusters were notably concentrated in specific counties within the Pearl River Delta. Conclusions: Significant spatiotemporal patterns of ONID in Guangdong Province from 2006 to 2022 were identified, characterized by a dramatic increase followed by stabilization in case numbers. ONID predominantly occur in manufacturing industries, domestically funded enterprises, among males, individuals aged 40?49 years, and those with 5+ years of occupational noise exposure. Spatial analysis demonstrated significant clustering in the Pearl River Delta region, with consistent positive spatial autocorrelation across years. These results could help prioritize the allocation of resources for targeted prevention and control measures for ONID. ",
doi="10.2196/57851",
url="https://publichealth.jmir.org/2024/1/e57851"
}


@Article{info:doi/10.2196/55562,
author="Kubickova, Veronika
and Steel, Craig
and Moulds, L. Michelle
and Kanstrup, Marie
and Beer, Sally
and Darwent, Melanie
and Keating, Liza
and Holmes, A. Emily
and Iyadurai, Lalitha",
title="Reducing the Number of Intrusive Memories of Work-Related Traumatic Events in Frontline Health Care Staff During the COVID-19 Pandemic: Case Series",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="18",
volume="11",
pages="e55562",
keywords="intrusive memories",
keywords="digital intervention",
keywords="psychological trauma",
keywords="remote delivery",
keywords="health care staff",
keywords="COVID-19",
keywords="case series",
abstract="Background: Frontline health care staff are frequently exposed to traumatic events as part of their work. Although this study commenced before the emergence of COVID-19, levels of exposure were heightened by the pandemic. Many health care staff members report intrusive memories of such events, which can elicit distress, affect functioning, and be associated with posttraumatic stress disorder symptoms in the long term. We need evidence-based interventions that are brief, preventative, nonstigmatizing, suitable for the working lives of frontline health care staff, and effective for repeated trauma exposure. A brief, guided imagery-competing task intervention involving a trauma reminder cue and Tetris gameplay may hold promise in this regard, given evidence that it can prevent and reduce the number of intrusive memories following trauma across various settings. Objective: This case series aims to investigate the impact of a brief imagery-competing task intervention on the number of intrusive memories, general functioning, and symptoms of posttraumatic stress, anxiety, and depression, and examine the feasibility and acceptability of the intervention for UK National Health Service frontline health care staff. The intervention was delivered with guidance from a clinical psychologist. Methods: We recruited 12 clinical staff from the UK National Health Service, specifically from emergency departments, the intensive care unit, and the ambulance service. We evaluated the intervention using an AB single-case experimental design, where the baseline (A) was the monitoring-only phase and the postintervention (B) period was the time after the intervention was first administered. Methods were adapted once the COVID-19 pandemic began. Results: There was a decrease (59\%) in the mean number of intrusive memories per day from baseline (mean 1.29, SD 0.94) to postintervention (mean 0.54, SD 0.51). There was a statistically significant reduction in the number of intrusive memories from baseline to postintervention, as shown by an aggregated omnibus analysis with a small effect size ($\tau$-U=--0.38; P<.001). Depression, anxiety, and posttraumatic stress symptoms all significantly reduced from preintervention to postintervention. Participants also reported improvements in functioning based on both quantitative and qualitative measures. The intervention was feasible to deliver and rated as acceptable by participants. Conclusions: These preliminary findings suggest that this brief therapist-guided imagery-competing task intervention offers a potential approach to mitigating the impact of work-related traumatic events in frontline health care staff, both during a pandemic and beyond. Randomized controlled trials will be an important next step. ",
doi="10.2196/55562",
url="https://humanfactors.jmir.org/2024/1/e55562"
}


@Article{info:doi/10.2196/60373,
author="Li, Shiyuan
and Yu, Xiao
and Ma, Xinrong
and Wang, Ying
and Guo, Junjie
and Wang, Jiping
and Shen, Wenxin
and Dong, Hongyu
and Salvi, Richard
and Wang, Hui
and Yin, Shankai",
title="Optimizing a Classification Model to Evaluate Individual Susceptibility in Noise-Induced Hearing Loss: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="14",
volume="10",
pages="e60373",
keywords="noise-induced hearing loss",
keywords="susceptible",
keywords="resistance",
keywords="machine learning algorithms",
keywords="linear regression",
keywords="extended high frequencies",
keywords="phenotypic characteristics",
keywords="genetic heterogeneity",
abstract="Background: Noise-induced hearing loss (NIHL), one of the leading causes of hearing loss in young adults, is a major health care problem that has negative social and economic consequences. It is commonly recognized that individual susceptibility largely varies among individuals who are exposed to similar noise. An objective method is, therefore, needed to identify those who are extremely sensitive to noise-exposed jobs to prevent them from developing severe NIHL. Objective: This study aims to determine an optimal model for detecting individuals susceptible or resistant to NIHL and further explore phenotypic traits uniquely associated with their susceptibility profiles. Methods: Cross-sectional data on hearing loss caused by occupational noise were collected from 2015 to 2021 at shipyards in Shanghai, China. Six methods were summarized from the literature review and applied to evaluate their classification performance for susceptibility and resistance of participants to NIHL. A machine learning (ML)--based diagnostic model using frequencies from 0.25 to 12 kHz was developed to determine the most reliable frequencies, considering accuracy and area under the curve. An optimal method with the most reliable frequencies was then constructed to detect individuals who were susceptible versus resistant to NIHL. Phenotypic characteristics such as age, exposure time, cumulative noise exposure, and hearing thresholds (HTs) were explored to identify these groups. Results: A total of 6276 participants (median age 41, IQR 33?47 years; n=5372, 85.6\% men) were included in the analysis. The ML-based NIHL diagnostic model with misclassified subjects showed the best performance for identifying workers in the NIHL-susceptible group (NIHL-SG) and NIHL-resistant group (NIHL-RG). The mean HTs at 4 and 12.5 kHz showed the highest predictive value for detecting those in the NIHL-SG and NIHL-RG (accuracy=0.78 and area under the curve=0.81). Individuals in the NIHL-SG selected by the optimized model were younger than those in the NIHL-RG (median 28, IQR 25?31 years vs median 35, IQR 32?39 years; P<.001), with a shorter duration of noise exposure (median 5, IQR 2?8 years vs median 8, IQR 4?12 years; P<.001) and lower cumulative noise exposure (median 90, IQR 86?92 dBA-years vs median 92.2, IQR 89.2?94.7 dBA-years; P<.001) but greater HTs (4 and 12.5 kHz; median 58.8, IQR 53.8?63.8 dB HL vs median 8.8, IQR 7.5?11.3 dB HL; P<.001). Conclusions: An ML-based NIHL diagnostic model with misclassified subjects using the mean HTs of 4 and 12.5 kHz was the most reliable method for identifying individuals susceptible or resistant to NIHL. However, further studies are needed to determine the genetic factors that govern NIHL susceptibility. Trial Registration: Chinese Clinical Trial Registry ChiCTR-RPC-17012580; https://www.chictr.org.cn/showprojEN.html?proj=21399 ",
doi="10.2196/60373",
url="https://publichealth.jmir.org/2024/1/e60373"
}


@Article{info:doi/10.2196/55874,
author="Widianti, Dini
and Mahardhika, Pribadi Zwasta
and Modjo, Robiana",
title="Development of a Mobile App for Occupational Stress Screening Among Female Workers: Protocol for an Exploratory Sequential Design Study",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="14",
volume="13",
pages="e55874",
keywords="mobile app",
keywords="study protocol",
keywords="occupational stress",
keywords="female workers",
keywords="stress",
keywords="screening",
keywords="worker",
keywords="app",
keywords="safety hazards",
keywords="technological innovation",
keywords="ergonomic",
keywords="psychological hazards",
keywords="mobile health",
keywords="digital platform",
keywords="algorithm",
abstract="Background: Occupational safety hazards include physical, chemical, ergonomic, biological, and psychological hazards. Technological innovation in screening for occupational stress, especially among female workers, is needed to improve their health and productivity. Objective: This research is being conducted to obtain a prediction model of work stress through a questionnaire instrument that includes stressors and symptoms based on the transactional model, as well as measurement of work stress through a mobile app that can be used anywhere. Methods: The research is conducted in 3 stages: qualitative research, quantitative research (cross-sectional), and mobile app development. Data were collected from companies located in Jakarta, Indonesia. The sample was chosen based on purposive sampling. For the quantitative research (n=430), logistic regression analysis was used. Results: We are developing a work stress screening instrument for female workers, which includes stressors and symptoms based on the transactional model, in the form of a digital platform so that female workers can undertake the examination anywhere without interfering with working hours or home duties. This research was funded in January 2024 and qualitative data collection began in February 2024. Quantitative data were obtained in March 2024; the number of respondents in the qualitative stage was 6, and in the quantitative stage it was 430. The work stress screening app is in the development stage and will be launched at the same time as the data collection is performed so we can examine the respondents' perspectives on the use of the app. Conclusions: This study analyzes the prediction of work stress to help female workers screen for work stress. Workers who are detected as experiencing work stress will be educated using an algorithm programmed in the app. International Registered Report Identifier (IRRID): PRR1-10.2196/55874 ",
doi="10.2196/55874",
url="https://www.researchprotocols.org/2024/1/e55874"
}


@Article{info:doi/10.2196/67634,
author="Carrouel, Florence
and du Sartz de Vigneulles, Benjamin
and Cl{\'e}ment, C{\'e}line
and Lvovschi, Virginie-Eve
and Verot, Elise
and Tantardini, Valeria
and Lamure, Michel
and Bourgeois, Denis
and Dussart, Claude
and Lan, Romain",
title="Authors' Reply: Promoting Oral Health Literacy Among UAE Public Sector Employees",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="12",
volume="10",
pages="e67634",
keywords="health literacy",
keywords="oral health literacy",
keywords="workplace",
keywords="civil servant",
keywords="health promotion",
keywords="prevention",
keywords="United Arab Emirates",
doi="10.2196/67634",
url="https://publichealth.jmir.org/2024/1/e67634"
}


@Article{info:doi/10.2196/66452,
author="Nair, C. Satish",
title="Promoting Oral Health Literacy Among UAE Public Sector Employees",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="12",
volume="10",
pages="e66452",
keywords="health literacy",
keywords="Gulf countries",
keywords="oral health literacy",
keywords="health promotion",
keywords="United Arab Emirates",
keywords="workplace",
doi="10.2196/66452",
url="https://publichealth.jmir.org/2024/1/e66452"
}


@Article{info:doi/10.2196/51865,
author="Lange-Drenth, Lukas
and Schulz, Holger
and Suck, Isabell
and Bleich, Christiane",
title="Barriers, Facilitators, and Requirements for a Telerehabilitation Aftercare Program for Patients After Occupational Injuries: Semistructured Interviews With Key Stakeholders",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="8",
volume="8",
pages="e51865",
keywords="telerehabilitation",
keywords="rehabilitation",
keywords="eHealth development",
keywords="value specification",
keywords="stakeholder participation",
keywords="occupational injuries",
keywords="vocational rehabilitation",
keywords="aftercare",
keywords="mobile phone",
abstract="Background: Patients with occupational injuries often receive multidisciplinary rehabilitation for a rapid return to work. Rehabilitation aftercare programs give patients the opportunity to help patients apply the progress they have made during the rehabilitation to their everyday activities. Telerehabilitation aftercare programs can help reduce barriers, such as lack of time due to other commitments, because they can be used regardless of time or location. Careful identification of barriers, facilitators, and design requirements with key stakeholders is a critical step in developing a telerehabilitation aftercare program. Objective: This study aims to identify barriers, facilitators, and design requirements for a future telerehabilitation aftercare program for patients with occupational injuries from the perspective of the key stakeholders. Methods: We used a literature review and expert recommendations to identify key stakeholders. We conducted semistructured interviews in person and via real-time video calls with 27 key stakeholders to collect data. Interviews were transcribed verbatim, and thematic analysis was applied. We selected key stakeholder statements about facilitators and barriers and categorized them as individual, technical, environmental, and organizational facilitators and barriers. We identified expressions that captured aspects that the telerehabilitation aftercare program should fulfill and clustered them into attributes and overarching values. We translated the attributes into one or more requirements and grouped them into content, functional, service, user experience, and work context requirements. Results: The key stakeholders identified can be grouped into the following categories: patients, health care professionals, administrative personnel, and members of the telerehabilitation program design and development team. The most frequently reported facilitators of a future telerehabilitation aftercare program were time savings for patients, high motivation of the patients to participate in telerehabilitation aftercare program, high usability of the program, and regular in-person therapy meetings during the telerehabilitation aftercare program. The most frequently reported barriers were low digital affinity and skills of the patients and personnel, patients' lack of trust and acceptance of the telerehabilitation aftercare program, slow internet speed, program functionality problems (eg, application crashes or freezes), and inability of telerehabilitation to deliver certain elements of in-person rehabilitation aftercare such as monitoring exercise performance. In our study, the most common design requirements were reducing barriers and implementing facilitators. The 2 most frequently discussed overarching values were tailoring of telerehabilitation, such as a tailored exercise plan and tailored injury-related information, and social interaction, such as real-time psychotherapy and digital and in-person rehabilitation aftercare in a blended care approach. Conclusions: Key stakeholders reported on facilitators, barriers, and design requirements that should be considered throughout the development process. Tailoring telerehabilitation content was the key value for stakeholders to ensure the program could meet the needs of patients with different types of occupational injuries. ",
doi="10.2196/51865",
url="https://formative.jmir.org/2024/1/e51865"
}


@Article{info:doi/10.2196/48696,
author="Nowels, Aideen Molly
and McDarby, Meghan
and Brody, Lilla
and Kleiman, Evan
and Sagui Henson, Sara
and Castro Sweet, Cynthia
and Kozlov, Elissa",
title="Predictors of Engagement in Multiple Modalities of Digital Mental Health Treatments: Longitudinal Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="7",
volume="26",
pages="e48696",
keywords="digital health",
keywords="mental health",
keywords="health care benefit",
keywords="prediction",
keywords="technology",
keywords="digital mental health",
keywords="employer-based",
keywords="teletherapy",
keywords="coaching",
keywords="utilization",
keywords="mobile phone",
abstract="Background: Technology-enhanced mental health platforms may serve as a pathway to accessible and scalable mental health care; specifically, those that leverage stepped care models have the potential to address many barriers to patient care, including low mental health literacy, mental health provider shortages, perceived acceptability of care, and equitable access to evidence-based treatment. Driving meaningful engagement in care through these platforms remains a challenge. Objective: This study aimed to examine predictors of engagement in self-directed digital mental health services offered as part of an employer-based mental health benefit that uses a technology-enabled care platform. Methods: Using a prospective, longitudinal design, we examined usage data from employees who had access to an employer-sponsored mental health care benefit. Participants had access to a digital library of mental health resources, which they could use at any time, including daily exercises, interactive programs, podcasts, and mindfulness exercises. Coaching and teletherapy were also available to. The outcome was engagement with the self-directed digital mental health resources, measured by the number of interactions. Poisson regression models included sociodemographic characteristics, patient activation, mental health literacy, well-being, PHQ-9 and GAD-7 scores at baseline, primary concern for engaging in treatment, and the use of coaching or teletherapy sessions. Results: In total 950 individuals enrolled in the study, with 38\% using any self-directed digital mental health resources. Approximately 44\% of the sample did not use the app during the study period. Those using both self-directed digital and 1:1 modalities made up about one-quarter of the sample (235/950, 24.7\%). Those using only coaching or therapy (170/950, 17.9\%) and those using only self-directed digital mental health resources (126/950, 13.3\%) make up the rest. At baseline, these groups statistically significantly differed on age, PHQ-9, GAD-7, MHLS, and primary concern. Receipt of coaching and teletherapy was associated with the number of self-directed digital mental health resources interactions in adjusted Poisson regression modeling. Use of any coach visit was associated with 82\% (rate ratio [RR] 1.82, 95\% CI 1.63-2.03) more self-directed digital mental health resource interactions while use of any teletherapy session was associated with 80\% (RR 1.80, 95\% CI 1.55-2.07) more digital mental health resources interactions (both P<.001). Each additional year of age was associated with increased digital mental health resources interactions (RR 1.04, 95\% CI (1.03-1.05), and women had 23\% more self-directed digital resources interactions than men (RR 1.23, 95\% CI 1.09-1.39). Conclusions: Our key finding was that the use of coaching or teletherapy was associated with increased self-directed digital mental health resource use. Higher self-directed digital resource engagement among those receiving coaching or therapy may be a result of provider encouragement. On the other hand, when a participant engages with 1 modality in the platform, they may be more likely to begin engaging with others, becoming ``super users'' of all resources. ",
doi="10.2196/48696",
url="https://www.jmir.org/2024/1/e48696"
}


@Article{info:doi/10.2196/50457,
author="Manning, B. Julia
and Blandford, Ann
and Edbrooke-Childs, Julian",
title="Facilitators of and Barriers to Teachers' Engagement With Consumer Technologies for Stress Management: Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="22",
volume="26",
pages="e50457",
keywords="teachers",
keywords="stress",
keywords="workplace",
keywords="self-management",
keywords="digital health",
keywords="technology",
keywords="qualitative",
keywords="context",
keywords="high schools",
keywords="wearables",
keywords="apps",
keywords="human-computer interaction",
keywords="HCI",
keywords="personal informatics",
abstract="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. ",
doi="10.2196/50457",
url="https://www.jmir.org/2024/1/e50457"
}


@Article{info:doi/10.2196/48481,
author="Freund, Johanna
and Smit, Filip
and Lehr, Dirk
and Zarski, Anna-Carlotta
and Berking, Matthias
and Riper, Heleen
and Funk, Burkhardt
and Ebert, Daniel David
and Buntrock, Claudia",
title="A Universal Digital Stress Management Intervention for Employees: Randomized Controlled Trial with Health-Economic Evaluation",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="22",
volume="26",
pages="e48481",
keywords="economic evaluation",
keywords="cost-effectiveness",
keywords="cost-utility",
keywords="cost-benefit",
keywords="return-on-investment",
keywords="employees",
keywords="universal prevention",
keywords="internet-based",
keywords="stress management",
abstract="Background: Stress is highly prevalent and known to be a risk factor for a wide range of physical and mental disorders. The effectiveness of digital stress management interventions has been confirmed; however, research on its economic merits is still limited. Objective: This study aims to assess the cost-effectiveness, cost-utility, and cost-benefit of a universal digital stress management intervention for employees compared with a waitlist control condition within a time horizon of 6 months. Methods: Recruitment was directed at the German working population. A sample of 396 employees was randomly assigned to the intervention group (n=198) or the waitlist control condition (WLC) group (n=198). The digital stress management intervention included 7 sessions plus 1 booster session, which was offered without therapeutic guidance. Health service use, patient and family expenditures, and productivity losses were self-assessed and used for costing from a societal and an employer's perspective. Costs were related to symptom-free status (PSS-10 [Perceived Stress Scale] score 2 SDs below the study population baseline mean) and quality-adjusted life years (QALYs) gained. The sampling error was handled using nonparametric bootstrapping. Results: From a societal perspective, the digital intervention was likely to be dominant compared with WLC, with a 56\% probability of being cost-effective at a willingness-to-pay (WTP) of {\texteuro}0 per symptom-free person gained. At the same WTP threshold, the digital intervention had a probability of 55\% being cost-effective per QALY gained relative to the WLC. This probability increased to 80\% at a societal WTP of {\texteuro}20,000 per QALY gained. Taking the employer's perspective, the digital intervention showed a probability of a positive return on investment of 78\%. Conclusions: Digital preventive stress management for employees appears to be cost-effective societally and provides a favorable return on investment for employers. Trial Registration: German Clinical Trials Register DRKS00005699; https://drks.de/search/en/trial/DRKS00005699 ",
doi="10.2196/48481",
url="https://www.jmir.org/2024/1/e48481"
}


@Article{info:doi/10.2196/49802,
author="Raussi, Venla
and Kujala, Sari
and H{\"o}rhammer, Iiris
and Savolainen, Kaisa
and Autio, Reija
and Koskela, Tuomas",
title="Comparing a Digital Health Check With Traditional Nurse-Led Health Examinations Among Long-Term Unemployed Individuals: Comparison Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="16",
volume="26",
pages="e49802",
keywords="chronic illnesses",
keywords="eHealth",
keywords="health care services",
keywords="lifestyle",
keywords="long-term unemployment",
keywords="digital health check",
keywords="primary prevention",
keywords="risk assessment",
keywords="risk factors",
keywords="prevention",
keywords="screening",
abstract="Background: A digital health check can be used to screen health behavior risks in the population, help health care professionals with standardized risk estimation for their patients, and motivate a patient to change unhealthy behaviors. Long-term unemployed individuals comprise a particular subgroup with an increased risk of lifestyle-related diseases. Objective: This study aims to investigate the clinical utility of a general digital health examination, the STAR Duodecim Health Check and Coaching Program (STAR), which was developed in Finland, in the targeted screening of long-term unemployed individuals. For this purpose, we compared health challenges identified by a digital health check with those identified by a nurse during a face-to-face health check for unemployed individuals. Methods: In this comparison study, 49 unemployed participants attending a health check were recruited from two Finnish primary health care centers. The participants used STAR and attended a nurse's health check. Data were collected by surveys with multiple-choice and open-ended questions from the participants, nurses, and a study assistant who observed the session. The nurses were asked to name the three most significant health challenges for each participant. These health challenges were categorized into health challenges corresponding to STAR and these were compared with each other. Percentages of agreement between STAR and nurses were calculated. Sensitivity and specificity, as well as Cohen $\kappa$ with P values and CIs, were computed for agreement. Results: STAR identified a total of 365 health challenges, an average of 7.4 (SD 2.5) health challenges per participant (n=49). The nurses named a total of 160 health challenges (n=47). In 53\% (95\% CI 38.1-67.9; n=25) of cases, STAR identified all categorized health challenges named by nurses. In 64\% (95\% CI 48.5-77.3; n=30) of cases, STAR identified at least 2/3 of the health challenges identified by nurses. Cohen $\kappa$ was 0.877 (P<.001) for alcohol, indicating almost perfect agreement, and 0.440 (P<.001) for smoking and 0.457 (P=.001) for cholesterol, indicating moderate agreement. STAR left a total of 89 health challenges, an average of 1.8 (SD 1.1) per participant, uncategorized because STAR lacked an answer to the question or questions required for the classification of a certain health challenge. The participants did not always add information on their blood pressure (n=36, 74\%), cholesterol (n=22, 45\%), and waist circumference (n=15, 31\%). Conclusions: In conclusion, STAR identified most of the health challenges identified by nurses but missed some essential ones. Participants did not have information on measurements, such as blood pressure and cholesterol values, which are pivotal to STAR in assessing cardiovascular risks. Using the tool for screening or as a part of a traditional health check with necessary measurements and dialog with health care professionals may improve the risk assessments and streamline the health checks of unemployed individuals. International Registered Report Identifier (IRRID): RR2-10.2196/27668 ",
doi="10.2196/49802",
url="https://www.jmir.org/2024/1/e49802",
url="http://www.ncbi.nlm.nih.gov/pubmed/39412874"
}


@Article{info:doi/10.2196/58692,
author="Abdullah Sharin, Ili
and Jinah, Norehan
and Bakit, Pangie
and Adnan, Khirman Izzuan
and Zakaria, Haniza Nor
and Mohmad, Shazwani
and Ahmad Subki, Zubaidah Siti
and Zakaria, Nursyahda
and Lee, Yun Kun",
title="Psychoeducational Burnout Intervention for Nurses: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="30",
volume="13",
pages="e58692",
keywords="burnout intervention",
keywords="burnout",
keywords="psychoeducation",
keywords="nurse",
keywords="systematic review",
keywords="protocol",
keywords="evidence-based intervention",
keywords="effectiveness",
keywords="psychoeducational intervention",
keywords="mental health.",
abstract="Background: Nurses face high levels of stress and emotional exhaustion due to heavy workloads and demanding work environments. Prolonged exposure to these stressors predisposes nurses to burnout, which can adversely affect patient care. Addressing burnout among nurses requires a multifaceted approach, involving both personal and organizational strategies. While organizational strategies target systemic workplace issues, personal interventions are often favored for their ease of implementation, immediate benefits, and empowerment of health care workers through stress management and resilience-building. Prioritizing evidence-based interventions to mitigate burnout among nurses is crucial for managing occupational stress and promoting well-being. Person-directed psychoeducation is an effective personal intervention strategy used to equip nurses with the appropriate knowledge and skills to handle stressors, thereby safeguarding their mental health and ensuring high-quality patient care. Objective: This protocol proposes a systematic review that aims to identify and assess the effectiveness of person-directed psychoeducational interventions for nurses. The review aims to pinpoint effective interventions that can be implemented to manage burnout and support the mental health of nurses. Methods: This systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. In total of 5 electronic databases (PubMed-MEDLINE, EBSCOhost, Ovid MEDLINE, Scopus, and ScienceDirect) will be searched for studies published between January 1, 2014, and December 31, 2023. The search will encompass 3 main keywords: ``nurses,'' ``burnout intervention,'' and ``burnout.'' Predefined eligibility criteria will guide the screening process. Data will be extracted to address the objectives of the review. The risk of bias for each study will be assessed using Joanna Briggs Institute Critical Appraisal Tools. Results: Preliminary searches have been initiated since February 2024, with the review expected to be completed by June 2024. The expected results will include a comprehensive list of psychoeducational interventions and their effectiveness in reducing burnout among nurses. The review will highlight interventions that demonstrate significant impact in published studies from various countries. Conclusions: Given the rising prevalence of burnout among nurses and its detrimental effects on individuals and health care organizations, the findings from this systematic review are expected to inform health care policy and practice. By evaluating different interventions, it will provide insights into the most effective strategies, contributing to evidence-based practices that support nurses' mental health and well-being. The findings can support stakeholders in developing and implementing targeted strategies to combat nurse burnout, ultimately enhancing the quality of patient care and health care delivery. In addition, the findings will also offer valuable information for researchers, guiding future practice and research in this area. Trial Registration: PROSPERO CRD42024505762; https://tinyurl.com/4p84dk3d International Registered Report Identifier (IRRID): DERR1-10.2196/58692 ",
doi="10.2196/58692",
url="https://www.researchprotocols.org/2024/1/e58692"
}


@Article{info:doi/10.2196/59900,
author="Spijker, A. Jeroen J.
and Barl?n, Hande
and Grad, Alecsandra Diana
and Gu, Yang
and Klavina, Aija
and Korkmaz Yaylagul, Nilufer
and Kulla, Gunilla
and Orhun, Eda
and {\vS}ev{\v c}{\'i}kov{\'a}, Anna
and Unim, Brigid
and Tofan, Maria Cristina",
title="The Impact of Digital Technology on the Physical Health of Older Workers: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="26",
volume="13",
pages="e59900",
keywords="digital tools",
keywords="digital technology",
keywords="digitalization",
keywords="physical health",
keywords="mobility",
keywords="vision loss",
keywords="musculoskeletal disorders",
keywords="migraine",
keywords="older workers",
keywords="older population",
keywords="aging",
keywords="scoping review",
keywords="mobile phone",
abstract="Background: Digital technologies have penetrated most workplaces. However, it is unclear how such digital technologies affect the physical health of older workers. Objective: This scoping review aims to examine and summarize the evidence from scientific literature concerning the impact of digital technology on the physical health of older workers. Methods: This scoping review will be conducted following recommendations outlined by Levac et al and will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines for reporting. Peer-reviewed papers written in English will be searched in the following databases: MEDLINE, Cochrane, ProQuest, Web of Science, Scopus, APA PsycInfo, and ERIH PLUS. The web-based systematic review platform Covidence will be used to create a data extraction template. It will cover the following items: study and participant characteristics, health measures, digital tool characteristics and usage, and research findings. Following the Population, Concept, and Context (PCC) framework, our review will focus on studies involving older workers aged 50 years or older, any form of digital technology (including teleworking and the use of digital tools at work), and how digital technologies affect physical health (such as vision loss, musculoskeletal disorders, and migraines). Studies that focus only on mental health will be excluded. Study selection based on title and abstract screening (first stage), full-text review (second stage), and data extraction (third stage) will be performed by a group of researchers, whereby each paper will be reviewed by at least 2 people. Any conflict regarding the inclusion or exclusion of a study and the data extraction will be resolved by discussion between the researchers who evaluated the papers; a third researcher will be involved if consensus is not reached. Results: A preliminary search of MEDLINE, Epistemonikos, Cochrane, PROSPERO, and JBI Evidence Synthesis was conducted, and no current or ongoing systematic reviews or scoping reviews on the topic were identified. The results of the study are expected in April 2025. Conclusions: Our scoping review will seek to provide an overview of the available evidence and identify research gaps regarding the effect of digital technology and the use of digital tools in the work environment on the physical health of older workers. International Registered Report Identifier (IRRID): PRR1-10.2196/59900 ",
doi="10.2196/59900",
url="https://www.researchprotocols.org/2024/1/e59900",
url="http://www.ncbi.nlm.nih.gov/pubmed/39325529"
}


@Article{info:doi/10.2196/48047,
author="Yun, Byungyoon
and Park, Heejoo
and Choi, Jaesung
and Oh, Juyeon
and Sim, Juho
and Kim, Yangwook
and Lee, Jongmin
and Yoon, Jin-Ha",
title="Inequality in Mortality and Cardiovascular Risk Among Young, Low-Income, Self-Employed Workers: Nationwide Retrospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="20",
volume="10",
pages="e48047",
keywords="self-employed",
keywords="employee",
keywords="all-cause mortality",
keywords="cardiovascular disease",
keywords="mental illness",
keywords="socioeconomic status",
keywords="nationwide study",
keywords="inequality",
keywords="effect modification",
keywords="health checkups",
abstract="Background: Self-employment is a significant component of South Korea's labor force; yet, it remains relatively understudied in the context of occupational safety and health. Owing to different guidelines for health checkup participation among economically active individuals, disparities in health maintenance may occur across varying employment statuses. Objective: This study aims to address such disparities by comparing the risk of all-cause mortality and comorbidities between the self-employed and employee populations in South Korea, using nationwide data. We sought to provide insights relevant to other countries with similar cultural, social, and economic contexts. Methods: This nationwide retrospective study used data from the Korean National Health Insurance Service database. Participants (aged 20?59 y) who maintained the same insurance type (self-employed or employee insurance) for ?3 years (at least 2008?2010) were recruited for this study and monitored until death or December 2021---whichever occurred first. The primary outcome was all-cause mortality. The secondary outcomes were ischemic heart disease, ischemic stroke, cancer, and hospitalization with a mental illness. Age-standardized cumulative incidence rates were estimated through an indirect method involving 5-unit age standardization. A multivariable Cox proportional hazards model was used to estimate the adjusted hazard ratio (HR) and 95\% CI for each sex stratum. Subgroup analyses and an analysis of the effect modification of health checkup participation were also performed. Results: A total of 11,652,716 participants were analyzed (follow-up: median 10.92, IQR 10.92-10.92 y; age: median 42, IQR 35-50 y; male: n=7,975,116, 68.44\%); all-cause mortality occurred in 1.27\% (99,542/7,851,282) of employees and 3.29\% (124,963/3,801,434) of self-employed individuals (P<.001). The 10-year cumulative incidence rates of all-cause mortality differed significantly by employment status (1.1\% for employees and 2.8\% for self-employed individuals; P<.001). The risk of all-cause mortality was significantly higher among the self-employed individuals when compared with that among employees, especially among female individuals, according to the final model (male: adjusted HR 1.44, 95\% CI 1.42?1.45; female: adjusted HR 1.89, 95\% CI 1.84?1.94; P<.001). The risk of the secondary outcomes, except all types of malignancies, was significantly higher among the self-employed individuals (all P values were <.001). According to subgroup analyses, this association was prominent in younger individuals with lower incomes who formed a part of the nonparticipation groups. Furthermore, health checkup participation acted as an effect modifier for the association between employment status and all-cause mortality in both sexes (male: relative excess risk due to interaction [RERI] 0.76, 95\% CI 0.74?0.79; female: RERI 1.13, 95\% CI 1.05?1.21). Conclusions: This study revealed that self-employed individuals face higher risks of all-cause mortality, cardio-cerebrovascular diseases, and mental illnesses when compared to employees. The mortality risk is particularly elevated in younger, lower-income individuals who do not engage in health checkups, with health checkup nonparticipation acting as an effect modifier for this association. ",
doi="10.2196/48047",
url="https://publichealth.jmir.org/2024/1/e48047"
}


@Article{info:doi/10.2196/48974,
author="Suh, Jina
and Howe, Esther
and Lewis, Robert
and Hernandez, Javier
and Saha, Koustuv
and Althoff, Tim
and Czerwinski, Mary",
title="Toward Tailoring Just-in-Time Adaptive Intervention Systems for Workplace Stress Reduction: Exploratory Analysis of Intervention Implementation",
journal="JMIR Ment Health",
year="2024",
month="Sep",
day="12",
volume="11",
pages="e48974",
keywords="workplace stress",
keywords="just-in-time",
keywords="just-in-time adaptive intervention",
keywords="JITAI",
keywords="engagement",
keywords="microintervention",
keywords="stress reduction",
keywords="psychotherapy",
abstract="Background: Integrating stress-reduction interventions into the workplace may improve the health and well-being of employees, and there is an opportunity to leverage ubiquitous everyday work technologies to understand dynamic work contexts and facilitate stress reduction wherever work happens. Sensing-powered just-in-time adaptive intervention (JITAI) systems have the potential to adapt and deliver tailored interventions, but such adaptation requires a comprehensive analysis of contextual and individual-level variables that may influence intervention outcomes and be leveraged to drive the system's decision-making. Objective: This study aims to identify key tailoring variables that influence momentary engagement in digital stress reduction microinterventions to inform the design of similar JITAI systems. Methods: To inform the design of such dynamic adaptation, we analyzed data from the implementation and deployment of a system that incorporates passively sensed data across everyday work devices to send just-in-time stress reduction microinterventions in the workplace to 43 participants during a 4-week deployment. We evaluated 27 trait-based factors (ie, individual characteristics), state-based factors (ie, workplace contextual and behavioral signals and momentary stress), and intervention-related factors (ie, location and function) across 1585 system-initiated interventions. We built logistical regression models to identify the factors contributing to momentary engagement, the choice of interventions, the engagement given an intervention choice, the user rating of interventions engaged, and the stress reduction from the engagement. Results: We found that women (odds ratio [OR] 0.41, 95\% CI 0.21-0.77; P=.03), those with higher neuroticism (OR 0.57, 95\% CI 0.39-0.81; P=.01), those with higher cognitive reappraisal skills (OR 0.69, 95\% CI 0.52-0.91; P=.04), and those that chose calm interventions (OR 0.43, 95\% CI 0.23-0.78; P=.03) were significantly less likely to experience stress reduction, while those with higher agreeableness (OR 1.73, 95\% CI 1.10-2.76; P=.06) and those that chose prompt-based (OR 6.65, 95\% CI 1.53-36.45; P=.06) or video-based (OR 5.62, 95\% CI 1.12-34.10; P=.12) interventions were substantially more likely to experience stress reduction. We also found that work-related contextual signals such as higher meeting counts (OR 0.62, 95\% CI 0.49-0.78; P<.001) and higher engagement skewness (OR 0.64, 95\% CI 0.51-0.79; P<.001) were associated with a lower likelihood of engagement, indicating that state-based contextual factors such as being in a meeting or the time of the day may matter more for engagement than efficacy. In addition, a just-in-time intervention that was explicitly rescheduled to a later time was more likely to be engaged with (OR 1.77, 95\% CI 1.32-2.38; P<.001). Conclusions: JITAI systems have the potential to integrate timely support into the workplace. On the basis of our findings, we recommend that individual, contextual, and content-based factors be incorporated into the system for tailoring as well as for monitoring ineffective engagements across subgroups and contexts. ",
doi="10.2196/48974",
url="https://mental.jmir.org/2024/1/e48974"
}


@Article{info:doi/10.2196/50356,
author="Abdul Aziz, Fadzlina Amani
and Ong, Tiffanie",
title="Real-World Outcomes of a Digital Behavioral Coaching Intervention to Improve Employee Health Status: Retrospective Observational Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Sep",
day="10",
volume="12",
pages="e50356",
keywords="digital behavioral coaching",
keywords="chronic disease management",
keywords="digital health",
keywords="mHealth",
keywords="workplace interventions",
keywords="mobile phone",
abstract="Background: Chronic noncommunicable diseases (NCDs) account for major disability and premature mortality worldwide, with low- and middle-income countries being disproportionately burdened. Given the negative impact of NCDs on employee performance and work productivity, there is a rising need for stakeholders to identify effective workplace solutions that can improve employee health outcomes. As the workplace becomes more dispersed post pandemic, digital behavioral coaching offers a scalable, personalized, and cost-effective method of managing chronic disease risk factors among employees. Objective: This study aimed to retrospectively evaluate the impact of a digital behavioral coaching program on year-to-year changes in employee health status in a cohort of Indonesian employees. Methods: This retrospective real-world exploratory analysis of secondary health data followed 774 employees of an Indonesian company who completed company-sponsored health screenings between 2021 and 2022 and were given access to Naluri (Naluri Hidup Sdn Bhd), a holistic digital therapeutics platform offering digital behavioral health coaching and self-help tools. Participants were retrospectively classified as those who received active coaching (n=177), passive coaching (n=108), and no coaching (n=489). Linear mixed-effects models were used to evaluate the year-to-year changes in health outcomes across the 3 employee groups, with post hoc analyses evaluating within-group differences between the 2 time points and between-group differences at follow-up. Results: Significant time{\texttimes}group interaction effects were detected for body weight, BMI, hemoglobin A1c, low-density lipoprotein, total cholesterol, and systolic and diastolic blood pressure. Post hoc pairwise comparisons revealed significant improvements in hemoglobin A1c (mean difference [Mdiff]=--0.14, P=.008), high-density lipoprotein (Mdiff=+2.14, P<.001), and total cholesterol (Mdiff=--11.45, P<.001) for employees in the Active Coaching group between 2021 and 2022, with the other 2 groups reporting deteriorations in multiple health outcomes throughout the 2 time points. At follow-up, those who received active coaching between 2021 and 2022 reported significantly lower body weight (P<.001), BMI (P=.001), low-density lipoprotein (P=.045), and total cholesterol (P<.001) than the No Coaching group. Conclusions: This study demonstrates real-world outcomes and implications supporting the use of workplace digital behavioral coaching in improving employee health status. Given the rising burden of NCDs in the Southeast Asian region, our findings underscore the role that workplace digital health interventions can play in preventing and managing chronic disease risk factors. ",
doi="10.2196/50356",
url="https://mhealth.jmir.org/2024/1/e50356",
url="http://www.ncbi.nlm.nih.gov/pubmed/39255013"
}


@Article{info:doi/10.2196/57384,
author="Aggarwal, Sumit
and Simmy, Simmy
and Mahajan, Nupur
and Nigam, Kuldeep",
title="Challenges Experienced by Health Care Workers During Service Delivery in the Geographically Challenging Terrains of North-East India: Study Involving a Thematic Analysis",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="10",
volume="8",
pages="e57384",
keywords="challenges",
keywords="thematic analysis",
keywords="infrastructure",
keywords="communication",
keywords="supply distribution",
keywords="resilience",
keywords="adaptability",
keywords="vaccination awareness",
keywords="innovative solutions",
abstract="Background: The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region's intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a study to identify health care workers' challenges and alternative strategies in Manipur and Nagaland. Objective: This study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India. Methods: This study is part of the i-DRONE (Indian Council of Medical Research's Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis. Results: Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future. Conclusions: Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland. ",
doi="10.2196/57384",
url="https://formative.jmir.org/2024/1/e57384",
url="http://www.ncbi.nlm.nih.gov/pubmed/39255009"
}


@Article{info:doi/10.2196/56283,
author="Liu, Kai
and Sun, Xin
and Hu, Wei-Jiang
and Mei, Liang-Ying
and Zhang, Heng-Dong
and Su, Shi-Biao
and Ning, Kang
and Nie, Yun-Feng
and Qiu, Le-Ping
and Xia, Ying
and Han, Lei
and Zhi, Qiang
and Shi, Chun-Bo
and Wang, Geng
and Wen, Wei
and Gao, Jian-Qiong
and Yu, Bing
and Wang, Xin
and Dong, Yi-Wen
and Kang, Ning
and Han, Feng
and Bian, Hong-Ying
and Chen, Yong-Qing
and Ye, Meng",
title="Occupational Exposure to Silica Dust and Silicosis Risk in Chinese Noncoal Mines: Qualitative and Quantitative Risk Assessment",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="2",
volume="10",
pages="e56283",
keywords="Chinese noncoal mine",
keywords="silica dust",
keywords="silicosis",
keywords="qualitative risk assessment",
keywords="quantitative risk assessment",
keywords="qualitative and quantitative risk assessment",
abstract="Background: Despite increasing awareness, silica dust--induced silicosis still contributes to the huge disease burden in China. Worryingly, recent silica dust exposure levels and silicosis risk in Chinese noncoal mines remain unclear. Objective: We aimed to determine recent silica dust exposure levels and assess the risk of silicosis in Chinese noncoal mines. Methods: Between May and December 2020, we conducted a retrospective cohort study on 3 noncoal mines and 1 public hospital to establish, using multivariable Cox regression analyses, prediction formulas of the silicosis cumulative hazard ratio (H) and incidence (I) and a cross-sectional study on 155 noncoal mines in 10 Chinese provinces to determine the prevalence of silica dust exposure (PDE), free silica content, and total dust and respirable dust concentrations. The qualitative risk of silicosis was assessed using the International Mining and Metals Commission's risk-rating table and the occupational hazard risk index; the quantitative risk was assessed using prediction formulas. Results: Kaplan-Meier survival analysis revealed significant differences in the silicosis probability between silica dust--exposed male and female miners (log-rank test $\chi$21=7.52, P=.01). A total of 126 noncoal mines, with 29,835 miners and 4623 dust samples, were included; 13,037 (43.7\%) miners were exposed to silica dust, of which 12,952 (99.3\%) were male. The median PDE, free silica content, total dust concentration, and respirable dust concentration were 61.6\%, 27.6\%, 1.30 mg/m3, and 0.58 mg/m3, respectively, indicating that miners in nonmetal, nonferrous metal, small, and open-pit mines suffer high-level exposure to silica dust. Comprehensive qualitative risk assessment showed noncoal miners had a medium risk of silicosis, and the risks caused by total silica dust and respirable silica dust exposure were high and medium, respectively. When predicting H and I over the next 10, 20, and 30 years, we assumed that the miner gender was male. Under exposure to current total silica dust concentrations, median I10, I20, and I30 would be 6.8\%, 25.1\%, and 49.9\%, respectively. Under exposure to current respirable silica dust concentrations, median I10, I20, and I30 would be 6.8\%, 27.7\%, and 57.4\%, respectively. These findings showed that miners in nonmetal, nonferrous metal, small, and open-pit mines have a higher I and higher qualitative silicosis risk. Conclusions: Chinese noncoal miners, especially those in nonmetal, nonferrous metal, small, and open-pit mines, still suffer high-level exposure to silica dust and a medium-level risk of silicosis. Data of both total silica dust and respirable silica dust are vital for occupational health risk assessment in order to devise effective control measures to reduce noncoal mine silica dust levels, improve miners' working environment, and reduce the risk of silicosis. ",
doi="10.2196/56283",
url="https://publichealth.jmir.org/2024/1/e56283",
url="http://www.ncbi.nlm.nih.gov/pubmed/39222341"
}


@Article{info:doi/10.2196/58942,
author="Carrouel, Florence
and du Sartz de Vigneulles, Benjamin
and Cl{\'e}ment, C{\'e}line
and Lvovschi, Virginie-Eve
and Verot, Elise
and Tantardini, Valeria
and Lamure, Michel
and Bourgeois, Denis
and Lan, Romain
and Dussart, Claude",
title="Promoting Health Literacy in the Workplace Among Civil Servants: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Aug",
day="15",
volume="10",
pages="e58942",
keywords="health literacy",
keywords="oral health literacy",
keywords="workplace",
keywords="civil servant",
keywords="health promotion",
keywords="prevention",
abstract="Background: In 2022, the World Health Organization highlighted the alarming state of oral health (OH) worldwide and urged action to include OH in initiatives on noncommunicable diseases. The population needs improved OH skills and attitudes and an adequate level of OH literacy (OHL) and general health literacy (HL). The implementation of health promotion actions in the workplace, which is a part of most people's lives, appears to be an opportunity. In France, civil servants have several socioprofessional levels and represent an excellent model with results transposable to the population. Objective: This study aimed at determining the OHL and HL level of civil servants in France in order to implement specific prevention actions in their workplaces. Methods: A cross-sectional study of French civil servants was conducted in France from October 2023 to February 2024. Participants completed three validated questionnaires in French: (1) a questionnaire on OH knowledge, (2) the Oral Health Literacy Instrument, French version (OHLI-F; this is composed of reading comprehension and numeracy sections) to assess the OHL level, and (3) the Short Test of Functional Health Literacy in Adults, French version (s-TOFHLA-F) to assess the HL level. The scores for OH knowledge, the OHLI-F, and the s-TOFHLA-F were reported as means (SD) and the 95\% CI. These scores were classified into 3 categories: adequate (75-100), marginal (60-74) and inadequate (0-59). ANOVA and binary logistic regression were performed. The OHLI-F reading comprehension and OHLI-F numeracy scores were compared using the Welch 2-sample t test and a paired t test (both 2-tailed). For the correlation matrix, the Pearson correlation and related tests were computed. Results: A total of 1917 persons completed the 3 questionnaires, with adequate levels of OHL (n=1610, 84\%), OH knowledge (n=1736, 90.6\%), and HL (n=1915, 99.9\%). The scores on the s-TOFHLA-F (mean 98.2, SD 2.8) were higher than the OHLI-F (mean 80.9, SD 7.9) and OH knowledge (mean 87.6, SD 10.5). The OHLI-F was highly correlated with OH knowledge (P<.001), but the OHLI-F and OH knowledge had a low correlation with s-TOFHLA-F (P=.43). The OHLI-F reading comprehension score was significantly higher than the OHLI-F numeracy score (P<.001). Age, education level, and professional category impacted the 3 scores (P<.001). The professional category was a determinant of adequate OHLI-F and OH knowledge scores. Conclusions: Some French civil servants had inadequate or marginal levels of OH knowledge (n=181, 9.5\%) and OHL (n=307, 16\%) but none had an inadequate level of HL. Results highlighted the relevance of implementing OH promotion programs in the workplace. They should be nonstandardized, adapted to the literacy level of professional categories of workers, and focused on numeracy skills. Thus, appropriate preventive communication and improved literacy levels are the means to achieve greater disease equity and combat the burden of noncommunicable diseases. ",
doi="10.2196/58942",
url="https://publichealth.jmir.org/2024/1/e58942"
}


@Article{info:doi/10.2196/57777,
author="B{\"a}lter, Katarina
and King, C. Abby
and Fritz, Johanna
and Tillander, Annika
and Halling Ullberg, Oskar",
title="Sustainable Lifestyle Among Office Workers (the SOFIA Study): Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Jul",
day="31",
volume="13",
pages="e57777",
keywords="diet",
keywords="physical activity",
keywords="work life",
keywords="health promotion",
keywords="climate change",
keywords="sustainable lifestyle",
keywords="citizen science",
keywords="Our Voice",
abstract="Background: Society is facing multiple challenges, including lifestyle- and age-related diseases of major public health relevance, and this is of particular importance when the general population, as well as the workforce, is getting older. In addition, we are facing global climate change due to extensive emissions of greenhouse gases and negative environmental effects. A lifestyle that promotes healthy life choices as well as climate and environmentally friendly decisions is considered a sustainable lifestyle. Objective: This study aims to evaluate if providing information about a sustainable lifestyle encourages individuals to adopt more nutritious dietary habits and increase physical activity, as compared to receiving information solely centered around health-related recommendations for dietary intake and physical activity by the Nordic Nutrition Recommendations and the World Health Organization. Novel features of this study include the use of the workplace as an arena for health promotion, particularly among office workers---a group known to be often sedentary at work and making up 60\% of all employees in Sweden. Methods: The Sustainable?Office?Intervention (SOFIA) study is a 2-arm, participant-blinded, cluster randomized controlled trial that includes a multilevel sustainable lifestyle arm (intervention arm, n=19) and a healthy lifestyle arm (control arm, n=14). The eligibility criteria were being aged 18-65 years and doing office work ?20 hours per week. Both intervention arms are embedded in the theoretically based behavioral change wheel method. The intervention study runs for approximately 8 weeks and contains 6 workshops. The study focuses on individual behavior change as well as environmental and policy features at an organizational level to facilitate or hinder a sustainable lifestyle at work. Through implementing a citizen science methodology within the trial, the participants (citizen scientists) collect data using the Stanford Our Voice Discovery Tool app and are involved in analyzing the data, formulating a list of potential actions to bring about feasible changes in the workplace. Results: Participant recruitment and data collection began in August 2022. As of June 2024, a total of 37 participants have been recruited. The results of the pilot phase are expected to be published in 2024 or 2025. Conclusions: Given the ongoing climate change, negative environmental effects, and the global epidemic of metabolic diseases, a sustainable lifestyle among office workers holds important potential to help in counteracting this trend. Thus, there is an urgent unmet need to test the impact of a sustainable lifestyle on food intake, physical activity, and environmental and climate impacts in a worksite-based randomized controlled trial. This study protocol responds to a societal need by addressing multilevel aspects, including individual behavior changes as well as environmental and organizational changes of importance for the successful implementation of sustainable lifestyle habits in an office setting. International Registered Report Identifier (IRRID): DERR1-10.2196/57777 ",
doi="10.2196/57777",
url="https://www.researchprotocols.org/2024/1/e57777",
url="http://www.ncbi.nlm.nih.gov/pubmed/39083333"
}


@Article{info:doi/10.2196/50253,
author="Barac, Milica
and Scaletty, Samantha
and Hassett, C. Leslie
and Stillwell, Ashley
and Croarkin, E. Paul
and Chauhan, Mohit
and Chesak, Sherry
and Bobo, V. William
and Athreya, P. Arjun
and Dyrbye, N. Liselotte",
title="Wearable Technologies for Detecting Burnout and Well-Being in Health Care Professionals: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="25",
volume="26",
pages="e50253",
keywords="wearable",
keywords="healthcare professionals",
keywords="burnout",
keywords="digital health",
keywords="mental health",
abstract="Background: The occupational burnout epidemic is a growing issue, and in the United States, up to 60\% of medical students, residents, physicians, and registered nurses experience symptoms. Wearable technologies may provide an opportunity to predict the onset of burnout and other forms of distress using physiological markers. Objective: This study aims to identify physiological biomarkers of burnout, and establish what gaps are currently present in the use of wearable technologies for burnout prediction among health care professionals (HCPs). Methods: A comprehensive search of several databases was performed on June 7, 2022. No date limits were set for the search. The databases were Ovid: MEDLINE(R), Embase, Healthstar, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science Core Collection via Clarivate Analytics, Scopus via Elsevier, EBSCOhost: Academic Search Premier, CINAHL with Full Text, and Business Source Premier. Studies observing anxiety, burnout, stress, and depression using a wearable device worn by an HCP were included, with HCP defined as medical students, residents, physicians, and nurses. Bias was assessed using the Newcastle Ottawa Quality Assessment Form for Cohort Studies. Results: The initial search yielded 505 papers, from which 10 (1.95\%) studies were included in this review. The majority (n=9) used wrist-worn biosensors and described observational cohort studies (n=8), with a low risk of bias. While no physiological measures were reliably associated with burnout or anxiety, step count and time in bed were associated with depressive symptoms, and heart rate and heart rate variability were associated with acute stress. Studies were limited with long-term observations (eg, ?12 months) and large sample sizes, with limited integration of wearable data with system-level information (eg, acuity) to predict burnout. Reporting standards were also insufficient, particularly in device adherence and sampling frequency used for physiological measurements. Conclusions: With wearables offering promise for digital health assessments of human functioning, it is possible to see wearables as a frontier for predicting burnout. Future digital health studies exploring the utility of wearable technologies for burnout prediction should address the limitations of data standardization and strategies to improve adherence and inclusivity in study participation. ",
doi="10.2196/50253",
url="https://www.jmir.org/2024/1/e50253",
url="http://www.ncbi.nlm.nih.gov/pubmed/38916948"
}


@Article{info:doi/10.2196/50195,
author="Buffey, John Aidan
and Langley, Kate Christina
and Carson, P. Brian
and Donnelly, E. Alan
and Salsberg, Jon",
title="Participatory Approaches in the Context of Research Into Workplace Health Promotion to Improve Physical Activity Levels and Reduce Sedentary Behavior Among Office-Based Workers: Scoping Review",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="19",
volume="10",
pages="e50195",
keywords="participatory research approach",
keywords="workplace health promotion",
keywords="physical activity",
keywords="sedentary behavior",
keywords="end user involvement",
keywords="office based",
keywords="desk based",
keywords="intervention",
keywords="cocreation",
keywords="public and patient involvement",
abstract="Background: Participatory research (PR) involves engaging in cocreation with end users and relevant stakeholders throughout the research process, aiming to distribute power equitably between the end users and research team. Engagement and adherence in previous workplace health promotion (WHP) studies have been shown to be lacking. By implementing a PR approach, the insights of end users and stakeholders are sought in the co-design of feasible and acceptable intervention strategies, thereby increasing the relevance of the research. Objective: This scoping review aims to explore, identify, and map PR techniques and their impact when used in office-based WHP interventions designed to improve physical activity (PA) or reduce sedentary behavior (SB). Methods: The reporting of this scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). A systematic literature search of 5 electronic databases---Web of Science, PubMed, Scopus, Google Scholar, and OpenGrey---was conducted, searching from January 1, 1995, to February 8, 2023. In total, 2 independent reviewers first screened the retrieved articles by title and abstract, and then assessed the full texts based on the inclusion and exclusion criteria. The search strategy and eligibility criteria were developed and guided by an a priori population (office-based working adults), intervention (a PA WHP intervention that took a PR approach), comparison (no comparison required), and outcome (PA or SB) framework. Data were charted and discussed via a narrative synthesis, and a thematic analysis was conducted. The included studies were evaluated regarding the degree of end user engagement throughout the research process and power shared by the researchers, using Arnstein's ladder of citizen participation. Results: The search retrieved 376 records, of which 8 (2.1\%) met the inclusion criteria. Four key strategies were identified: (1) end user focus groups, (2) management involvement, (3) researcher facilitators, and (4) workplace champions. The degree of engagement and power shared was relatively low, with 25\% (2/8) of the studies determined to be nonparticipation studies, 25\% (2/8) determined to be tokenistic, and 50\% (4/8) determined to provide citizen power. Conclusions: This review provides a foundation of evidence on the current practices when taking a PR approach, highlighting that previous office-based PA WHP studies have been largely tokenistic or nonparticipative, and identified that the end user is only engaged with in the conception and implementation of the WHP studies. However, a positive improvement in PA and reduction in SB were observed in the included studies, which were largely attributed to implementing a PR approach and including the end user in the design of the WHP intervention. Future studies should aim to collaborate with workplaces, building capacity and empowering the workforce by providing citizen control and letting the end users ``own'' the research for a sustainable WHP intervention. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-054402 ",
doi="10.2196/50195",
url="https://publichealth.jmir.org/2024/1/e50195",
url="http://www.ncbi.nlm.nih.gov/pubmed/38896458"
}


@Article{info:doi/10.2196/49581,
author="Wekenborg, Katharina Magdalena
and F{\"o}rster, Katharina
and Schweden, Florian
and Weidemann, Robin
and Bechtolsheim, von Felix
and Kirschbaum, Clemens
and Weitz, J{\"u}rgen
and Ditzen, Beate",
title="Differences in Physicians' Ratings of Work Stressors and Resources Associated With Digital Transformation: Cross-Sectional Study",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="17",
volume="26",
pages="e49581",
keywords="physicians",
keywords="digital transformation",
keywords="chronic stress",
keywords="hair cortisol concentration",
keywords="work stressors",
keywords="work resources",
abstract="Background: The emergence of the COVID-19 pandemic rapidly accelerated the need and implementation of digital innovations, especially in medicine. Objective: To gain a better understanding of the stress associated with digital transformation in physicians, this study aims to identify working conditions that are stress relevant for physicians and differ in dependence on digital transformation. In addition, we examined the potential role of individual characteristics (ie, age, gender, and actual implementation of a digital innovation within the last 3 years) in digitalization-associated differences in these working conditions. Methods: Cross-sectional web-based questionnaire data of 268 physicians (mean age 40.9, SD 12.3 y; n=150, 56\% women) in Germany were analyzed. Physicians rated their chronic stress level and 11 relevant working conditions (ie, work stressors such as time pressure and work resources such as influence on sequence) both before and after either a fictional or real implementation of a relevant digital transformation at their workplace. In addition, a subsample of individuals (60; n=33, 55\% women) submitted self-collected hair samples for cortisol analysis. Results: The stress relevance of the selected working conditions was confirmed by significant correlations with self-rated chronic stress and hair cortisol levels (hair F) within the sample, all of them in the expected direction (P values between .01 and <.001). Multilevel modeling revealed significant differences associated with digital transformation in the rating of 8 (73\%) out of 11 working conditions. More precisely, digital transformation was associated with potentially stress-enhancing effects in 6 working conditions (ie, influence on procedures and complexity of tasks) and stress-reducing effects in 2 other working conditions (ie, perceived workload and time pressure). Younger individuals, women, and individuals whose workplaces have implemented digital innovations tended to perceive digitalization-related differences in working conditions as rather stress-reducing. Conclusions: Our study lays the foundation for future hypothesis-based longitudinal research by identifying those working conditions that are stress relevant for physicians and prone to differ as a function of digital transformation and individual characteristics. ",
doi="10.2196/49581",
url="https://www.jmir.org/2024/1/e49581",
url="http://www.ncbi.nlm.nih.gov/pubmed/38885014"
}


@Article{info:doi/10.2196/54811,
author="Wu, Yuxuan
and Wu, Mingyue
and Wang, Changyu
and Lin, Jie
and Liu, Jialin
and Liu, Siru",
title="Evaluating the Prevalence of Burnout Among Health Care Professionals Related to Electronic Health Record Use: Systematic Review and Meta-Analysis",
journal="JMIR Med Inform",
year="2024",
month="Jun",
day="12",
volume="12",
pages="e54811",
keywords="clinical decision support system",
keywords="electronic health record",
keywords="electronic medical record",
keywords="health information technology",
keywords="alert fatigue",
keywords="burnout",
keywords="health care professionals",
keywords="health care service",
keywords="EHR",
keywords="systematic review",
keywords="meta-analysis",
keywords="health information system",
keywords="clinician burnout",
keywords="health informatics",
abstract="Background: Burnout among health care professionals is a significant concern, with detrimental effects on health care service quality and patient outcomes. The use of the electronic health record (EHR) system has been identified as a significant contributor to burnout among health care professionals. Objective: This systematic review and meta-analysis aims to assess the prevalence of burnout among health care professionals associated with the use of the EHR system, thereby providing evidence to improve health information systems and develop strategies to measure and mitigate burnout. Methods: We conducted a comprehensive search of the PubMed, Embase, and Web of Science databases for English-language peer-reviewed articles published between January 1, 2009, and December 31, 2022. Two independent reviewers applied inclusion and exclusion criteria, and study quality was assessed using the Joanna Briggs Institute checklist and the Newcastle-Ottawa Scale. Meta-analyses were performed using R (version 4.1.3; R Foundation for Statistical Computing), with EndNote X7 (Clarivate) for reference management. Results: The review included 32 cross-sectional studies and 5 case-control studies with a total of 66,556 participants, mainly physicians and registered nurses. The pooled prevalence of burnout among health care professionals in cross-sectional studies was 40.4\% (95\% CI 37.5\%-43.2\%). Case-control studies indicated a higher likelihood of burnout among health care professionals who spent more time on EHR-related tasks outside work (odds ratio 2.43, 95\% CI 2.31-2.57). Conclusions: The findings highlight the association between the increased use of the EHR system and burnout among health care professionals. Potential solutions include optimizing EHR systems, implementing automated dictation or note-taking, employing scribes to reduce documentation burden, and leveraging artificial intelligence to enhance EHR system efficiency and reduce the risk of burnout. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021281173; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42021281173 ",
doi="10.2196/54811",
url="https://medinform.jmir.org/2024/1/e54811",
url="http://www.ncbi.nlm.nih.gov/pubmed/38865188"
}


@Article{info:doi/10.2196/55014,
author="Hong, Chong Hye
and Kim, Man Young",
title="Multimorbidity and its Associated Factors in Korean Shift Workers: Population-Based Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="10",
volume="10",
pages="e55014",
keywords="chronic disease",
keywords="multimorbidity",
keywords="shift work schedule",
keywords="shift workers",
keywords="population-based study",
keywords="Korea",
keywords="network analysis",
keywords="logistic regression",
keywords="cross-sectional study",
keywords="public health",
abstract="Background: Multimorbidity is a crucial factor that influences premature death rates, poor health, depression, quality of life, and use of health care. Approximately one-fifth of the global workforce is involved in shift work, which is associated with increased risk for several chronic diseases and multimorbidity. About 12\% to 14\% of wage workers in Korea are shift workers. However, the prevalence of multimorbidity and its associated factors in Korean shift workers are rarely reported. Objective: This study aimed to assess multimorbidity prevalence, examine the factors associated with multimorbidity, and identify multimorbidity patterns among shift workers in Korea. Methods: This study is a population-based cross-sectional study using Korea National Health and Nutrition Examination Survey data from 2016 to 2020. The study included 1704 (weighted n=2,697,228) Korean shift workers aged 19 years and older. Multimorbidity was defined as participants having 2 or more chronic diseases. Demographic and job-related variables, including regular work status, average working hours per week, and shift work type, as well as health behaviors, including BMI, smoking status, alcohol use, physical activity, and sleep duration, were included in the analysis. A survey-corrected logistic regression analysis was performed to identify factors influencing multimorbidity among the workers, and multimorbidity patterns were identified with a network analysis. Results: The overall prevalence of multimorbidity was 13.7\% (302/1704). Logistic regression indicated that age, income, regular work, and obesity were significant factors influencing multimorbidity. Network analysis results revealed that chronic diseases clustered into three groups: (1) cardiometabolic multimorbidity (hypertension, dyslipidemia, diabetes, coronary heart disease, and stroke), (2) musculoskeletal multimorbidity (arthritis and osteoporosis), and (3) unclassified diseases (depression, chronic liver disease, thyroid disease, asthma, cancer, and chronic kidney disease). Conclusions: The findings revealed that several socioeconomic and behavioral factors were associated with multimorbidity among shift workers, indicating the need for policy development related to work schedule modification. Further organization-level screening and intervention programs are needed to prevent and manage multimorbidity among shift workers. We also recommend longitudinal studies to confirm the effects of job-related factors and health behaviors on multimorbidity among shift workers in the future. ",
doi="10.2196/55014",
url="https://publichealth.jmir.org/2024/1/e55014",
url="http://www.ncbi.nlm.nih.gov/pubmed/38857074"
}


@Article{info:doi/10.2196/49450,
author="Li, Weicong
and Tang, Maggie Liyaning
and Montayre, Jed
and Harris, B. Celia
and West, Sancia
and Antoniou, Mark",
title="Investigating Health and Well-Being Challenges Faced by an Aging Workforce in the Construction and Nursing Industries: Computational Linguistic Analysis of Twitter Data",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="5",
volume="26",
pages="e49450",
keywords="social media",
keywords="construction",
keywords="nursing",
keywords="aging",
keywords="health and well-being",
keywords="Twitter",
abstract="Background: Construction and nursing are critical industries. Although both careers involve physically and mentally demanding work, the risks to workers during the COVID-19 pandemic are not well understood. Nurses (both younger and older) are more likely to experience the ill effects of burnout and stress than construction workers, likely due to accelerated work demands and increased pressure on nurses during the COVID-19 pandemic. In this study, we analyzed a large social media data set using advanced natural language processing techniques to explore indicators of the mental status of workers across both industries before and during the COVID-19 pandemic. Objective: This social media analysis aims to fill a knowledge gap by comparing the tweets of younger and older construction workers and nurses to obtain insights into any potential risks to their mental health due to work health and safety issues. Methods: We analyzed 1,505,638 tweets published on Twitter (subsequently rebranded as X) by younger and older (aged <45 vs >45 years) construction workers and nurses. The study period spanned 54 months, from January 2018 to June 2022, which equates to approximately 27 months before and 27 months after the World Health Organization declared COVID-19 a global pandemic on March 11, 2020. The tweets were analyzed using big data analytics and computational linguistic analyses. Results: Text analyses revealed that nurses made greater use of hashtags and keywords (both monograms and bigrams) associated with burnout, health issues, and mental health compared to construction workers. The COVID-19 pandemic had a pronounced effect on nurses' tweets, and this was especially noticeable in younger nurses. Tweets about health and well-being contained more first-person singular pronouns and affect words, and health-related tweets contained more affect words. Sentiment analyses revealed that, overall, nurses had a higher proportion of positive sentiment in their tweets than construction workers. However, this changed markedly during the COVID-19 pandemic. Since early 2020, sentiment switched, and negative sentiment dominated the tweets of nurses. No such crossover was observed in the tweets of construction workers. Conclusions: The social media analysis revealed that younger nurses had language use patterns consistent with someone experiencing the ill effects of burnout and stress. Older construction workers had more negative sentiments than younger workers, who were more focused on communicating about social and recreational activities rather than work matters. More broadly, these findings demonstrate the utility of large data sets enabled by social media to understand the well-being of target populations, especially during times of rapid societal change. ",
doi="10.2196/49450",
url="https://www.jmir.org/2024/1/e49450",
url="http://www.ncbi.nlm.nih.gov/pubmed/38838308"
}


@Article{info:doi/10.2196/47546,
author="Gonz{\'a}lez-Spinoglio, Leticia
and Monistrol-Mula, Anna
and Vindrola-Padros, Cecilia
and Aguilar-Ortiz, Salvatore
and Carreras, Bernat
and Haro, Maria Josep
and Felez-Nobrega, Mireia",
title="Long-Term Emotional Impact of the COVID-19 Pandemic and Barriers and Facilitators to Digital Mental Health Tools in Long-Term Care Workers: Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="May",
day="29",
volume="26",
pages="e47546",
keywords="COVID-19 pandemic",
keywords="digital technology",
keywords="health care professionals",
keywords="long-term care",
keywords="mental health",
keywords="well-being",
keywords="digital mental health",
keywords="digital mental health interventions",
keywords="mobile phone",
abstract="Background: The overall pandemic created enormous pressure on long-term care workers (LTCWs), making them particularly vulnerable to mental disorders. Despite this, most of the available evidence on professional well-being during COVID-19 has exclusively focused on frontline health care workers. Objective: This study aimed to identify the long-term psychological needs of LTCWs derived from the COVID-19 pandemic and to explore barriers and facilitators related to digital mental health tools. This is part of a project that seeks to develop a digital mental health intervention to reduce psychological distress in this population group. Methods: We performed a qualitative study with a rapid research approach. Participants were LTCWs of the autonomous community of Catalonia. We conducted 30 semistructured interviews between April and September 2022. We used a qualitative content analysis method with an inductive-deductive approach. Results: The period of the pandemic with the highest mental health burden was the COVID-19 outbreak, with almost all workers having experienced some form of emotional distress. Emotional distress persisted over time in more than half of the participants, with fatigue and nervousness being the main emotions expressed at the time of the interview. High workload, the feeling that pandemic times are not over, and poor working conditions that have remained since then have been the most frequently expressed determinants of such emotions. Potential barriers and facilitators to engagement with digital tools were also identified in terms of previous experience and beliefs of the target population, possibilities for the integration of a digital tool into daily life, preferences regarding the level of guidance, the possibility of social connectedness through the tool, and privacy and confidentiality. The identified factors may become especially relevant in the context of the pandemic remission phase. Conclusions: More than 2 years after the pandemic outbreak, emotional distress is still relevant. The persistent burden of psychological distress points to a need for institutions to take action to improve working conditions and promote employees' well-being. Considering factors that act as barriers and facilitators for the use of digital mental health tools, it is important to develop tailored tools that could offer valuable support to this population during and after a pandemic. ",
doi="10.2196/47546",
url="https://www.jmir.org/2024/1/e47546",
url="http://www.ncbi.nlm.nih.gov/pubmed/38809605"
}


@Article{info:doi/10.2196/55529,
author="Batterham, J. Philip
and Gulliver, Amelia
and Heffernan, Cassandra
and Calear, L. Alison
and Werner-Seidler, Aliza
and Turner, Alyna
and Farrer, M. Louise
and Chatterton, Lou Mary
and Mihalopoulos, Cathrine
and Berk, Michael",
title="A Brief Workplace Training Program to Support Help-Seeking for Mental Ill-Health: Protocol for the Helipad Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="24",
volume="13",
pages="e55529",
keywords="help seeking",
keywords="mental health",
keywords="workplace",
keywords="employee",
keywords="implementation",
keywords="internet",
keywords="psychiatry",
keywords="psychology",
keywords="mobile phone",
abstract="Background: Most people with mental health problems do not seek help, with delays of even decades in seeking professional help. Lack of engagement with professional mental health services can lead to poor outcomes and functional impairment. However, few effective interventions have been identified to improve help-seeking in adults, and those that exist are not widely implemented to deliver public health impact. Co-designing interventions with people with lived experience of mental ill-health and other relevant stakeholders is critical to increase the likelihood of uptake and engagement with these programs. Objective: This study aims to (1) test the effectiveness of a co-designed help-seeking program on increasing professional help-seeking intentions in employees in a workplace setting; (2) determine whether the program reduces mental illness stigma and improves help-seeking intentions and behavior, mental health literacy, mental health symptoms, and work and activity functioning relative to the control condition; (3) explore factors that facilitate broader implementation of the co-designed program; and (4) explore the cost-effectiveness of the co-designed program compared to the control condition over 6 months. Methods: A 2-arm cluster randomized controlled trial will be conducted (target sample: N=900 from 30 to 36 workplaces, with n=25 to 35 participants per workplace). The trial will compare the relative effectiveness of an enhanced interactive program (intervention condition) with a standard psychoeducation-alone program (active control condition) on the primary outcome of professional help-seeking intentions as measured by the General Help-Seeking Questionnaire. Secondary outcomes include the impact on mental illness stigma; mental health literacy; help-seeking attitudes and behavior; work and activity functioning; quality of life; and symptoms of mental ill-health including depression, anxiety, and general psychological distress. Results: Facilitators of and risks to the trial are identified and addressed in this protocol. Recruitment of workplaces is scheduled to commence in the first quarter of 2024. Conclusions: If effective, the program has the potential to be ready for rapid dissemination throughout Australia, with the potential to increase appropriate and efficient service use across the spectrum of evidence-based services. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000270617p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385376 International Registered Report Identifier (IRRID): PRR1-10.2196/55529 ",
doi="10.2196/55529",
url="https://www.researchprotocols.org/2024/1/e55529",
url="http://www.ncbi.nlm.nih.gov/pubmed/38787608"
}


@Article{info:doi/10.2196/56267,
author="Bieri, Stefan Jannic
and Ikae, Catherine
and Souissi, Ben Souhir
and M{\"u}ller, J{\"o}rg Thomas
and Schlunegger, Charlotte Margarithe
and Golz, Christoph",
title="Natural Language Processing for Work-Related Stress Detection Among Health Professionals: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="15",
volume="13",
pages="e56267",
keywords="health professionals",
keywords="natural language processing",
keywords="text-mining",
keywords="work-related stress",
keywords="healthcare",
keywords="occupational well-being",
keywords="automatic detection",
keywords="scoping review protocol",
keywords="methodology",
keywords="synthesis",
abstract="Background: There is an urgent need worldwide for qualified health professionals. High attrition rates among health professionals, combined with a predicted rise in life expectancy, further emphasize the need for additional health professionals. Work-related stress is a major concern among health professionals, affecting both the well-being of health professionals and the quality of patient care. Objective: This scoping review aims to identify processes and methods for the automatic detection of work-related stress among health professionals using natural language processing (NLP) and text mining techniques. Methods: This review follows Joanna Briggs Institute Methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The inclusion criteria for this scoping review encompass studies involving health professionals using NLP for work-related stress detection while excluding studies involving other professions or children. The review focuses on various aspects, including NLP applications for stress detection, criteria for stress identification, technical aspects of NLP, and implications of stress detection through NLP. Studies within health care settings using diverse NLP techniques are considered, including experimental and observational designs, aiming to provide a comprehensive understanding of NLP's role in detecting stress among health professionals. Studies published in English, German, or French from 2013 to present will be considered. The databases to be searched include MEDLINE (via PubMed), CINAHL, PubMed, Cochrane, ACM Digital Library, and IEEE Xplore. Sources of unpublished studies and gray literature to be searched will include ProQuest Dissertations \& Theses and OpenGrey. Two reviewers will independently retrieve full-text studies and extract data. The collected data will be organized in tables, graphs, and a qualitative narrative summary. This review will use tables and graphs to present data on studies' distribution by year, country, activity field, and research methods. Results synthesis involves identifying, grouping, and categorizing. The final scoping review will include a narrative written report detailing the search and study selection process, a visual representation using a PRISMA-ScR flow diagram, and a discussion of implications for practice and research. Results: We anticipate the outcomes will be presented in a systematic scoping review by June 2024. Conclusions: This review fills a literature gap by identifying automated work-related stress detection among health professionals using NLP and text mining, providing insights on an innovative approach, and identifying research needs for further systematic reviews. Despite promising outcomes, acknowledging limitations in the reviewed studies, including methodological constraints, sample biases, and potential oversight, is crucial to refining methodologies and advancing automatic stress detection among health professionals. International Registered Report Identifier (IRRID): PRR1-10.2196/56267 ",
doi="10.2196/56267",
url="https://www.researchprotocols.org/2024/1/e56267",
url="http://www.ncbi.nlm.nih.gov/pubmed/38749026"
}


@Article{info:doi/10.2196/55374,
author="Bodnaru, Alexandra
and Rusu, Andrei
and V{\^i}rg?, Delia
and Van den Broeck, Anja
and Blonk, B. Roland W.
and Tranc?, Marcela Loredana
and Iliescu, Drago?",
title="Efficacy of the iJobs Web-Based Psychoeducational Intervention to Improve Job Search Behavior and Promote Mental Health Among Unemployed People: Protocol for a Waitlist Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="8",
volume="13",
pages="e55374",
keywords="iJobs",
keywords="JOBS II program",
keywords="employability",
keywords="internet intervention",
keywords="randomized-controlled trial",
abstract="Background: Unemployment affects millions of people worldwide and, beyond its economic impact, has severe implications for people's well-being and mental health. Different programs have been developed in response to this phenomenon, but to date, job-search interventions have proved to be most effective, especially the JOBS II program. The JOBS II program proved not only to be effective for re-employment but also has a positive impact on beneficiaries' mental health (ie, reduces anxiety or depression). However, by now, this evidence-based program has been delivered only on site in the various countries where it was implemented. In the digital era, web-based alternatives to such programs are highly needed because they have the advantages of scalability and cost-effectiveness. Objective: In this context, we aim to investigate the efficacy of iJobs, the web-based adaptation of the JOBS II program, on job-search intensity and effort, the quality of job-search behaviors, and job-search self-efficacy. Further, 1 month after the intervention, we will also assess the employment status and the satisfaction with the job (if applicable). This study will also investigate the effect of iJobs on well-being and mental health (ie, anxiety and depression). Methods: This study is a 2-arm randomized controlled trial. The 2 independent groups (intervention vs waiting list control group) will be crossed with 3 measurement times (ie, baseline, the postintervention time point, and 1-month follow-up). The design will be a 2 (intervention vs control) {\texttimes} 3 (baseline, the postintervention time point, and 1-month follow-up) factorial design. iJobs is a 2-week intervention consisting of 6 modules: an introductive module and 5 modules adapted from the original JOBS II program to the web-based setting and Romanian population. The web-based intervention also has a human component, as beneficiaries receive personalized written feedback after each module on the platform from a team of psychologists involved in the project. Results: The enrollment of study participants started in June 2023 and is expected to end in May 2024. The data collection is expected to be completed by July 2024. The results are expected to be submitted for publication in the summer of 2024. Conclusions: This study is the first large-scale randomized controlled trial aiming to test the efficacy of a web-based adaptation of the JOBS II program. If our results support the efficacy of iJobs, they will offer the premise for it to become an evidence-based, accessible alternative for unemployed people in Romania and might be implemented in other countries. Trial Registration: ClinicalTrials.gov NCT05962554; https://clinicaltrials.gov/study/NCT05962554 International Registered Report Identifier (IRRID): PRR1-10.2196/55374 ",
doi="10.2196/55374",
url="https://www.researchprotocols.org/2024/1/e55374",
url="http://www.ncbi.nlm.nih.gov/pubmed/38717812"
}


@Article{info:doi/10.2196/54180,
author="Martin, Josh
and Rueda, Alice
and Lee, Hee Gyu
and Tassone, K. Vanessa
and Park, Haley
and Ivanov, Martin
and Darnell, C. Benjamin
and Beavers, Lindsay
and Campbell, M. Douglas
and Nguyen, Binh
and Torres, Andrei
and Jung, Hyejung
and Lou, Wendy
and Nazarov, Anthony
and Ashbaugh, Andrea
and Kapralos, Bill
and Litz, Brett
and Jetly, Rakesh
and Dubrowski, Adam
and Strudwick, Gillian
and Krishnan, Sridhar
and Bhat, Venkat",
title="Digital Interventions to Understand and Mitigate Stress Response: Protocol for Process and Content Evaluation of a Cohort Study",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="6",
volume="13",
pages="e54180",
keywords="web-based platform",
keywords="stress",
keywords="distress",
keywords="moral distress",
keywords="wearable",
keywords="oura ring",
keywords="virtual reality",
keywords="VR",
keywords="COVID-19",
keywords="nursing",
keywords="digital health implementation",
abstract="Background: Staffing and resource shortages, especially during the COVID-19 pandemic, have increased stress levels among health care workers. Many health care workers have reported feeling unable to maintain the quality of care expected within their profession, which, at times, may lead to moral distress and moral injury. Currently, interventions for moral distress and moral injury are limited. Objective: This study has the following aims: (1) to characterize and reduce stress and moral distress related to decision-making in morally complex situations using a virtual reality (VR) scenario and a didactic intervention; (2) to identify features contributing to mental health outcomes using wearable, physiological, and self-reported questionnaire data; and (3) to create a personal digital phenotype profile that characterizes stress and moral distress at the individual level. Methods: This will be a single cohort, pre- and posttest study of 100 nursing professionals in Ontario, Canada. Participants will undergo a VR simulation that requires them to make morally complex decisions related to patient care, which will be administered before and after an educational video on techniques to mitigate distress. During the VR session, participants will complete questionnaires measuring their distress and moral distress, and physiological data (electrocardiogram, electrodermal activity, plethysmography, and respiration) will be collected to assess their stress response. In a subsequent 12-week follow-up period, participants will complete regular assessments measuring clinical outcomes, including distress, moral distress, anxiety, depression, and loneliness. A wearable device will also be used to collect continuous data for 2 weeks before, throughout, and for 12 weeks after the VR session. A pre-post comparison will be conducted to analyze the effects of the VR intervention, and machine learning will be used to create a personal digital phenotype profile for each participant using the physiological, wearable, and self-reported data. Finally, thematic analysis of post-VR debriefing sessions and exit interviews will examine reoccurring codes and overarching themes expressed across participants' experiences. Results: The study was funded in 2022 and received research ethics board approval in April 2023. The study is ongoing. Conclusions: It is expected that the VR scenario will elicit stress and moral distress. Additionally, the didactic intervention is anticipated to improve understanding of and decrease feelings of stress and moral distress. Models of digital phenotypes developed and integrated with wearables could allow for the prediction of risk and the assessment of treatment responses in individuals experiencing moral distress in real-time and naturalistic contexts. This paradigm could also be used in other populations prone to moral distress and injury, such as military and public safety personnel. Trial Registration: ClinicalTrials.gov NCT05923398; https://clinicaltrials.gov/study/NCT05923398 International Registered Report Identifier (IRRID): DERR1-10.2196/54180 ",
doi="10.2196/54180",
url="https://www.researchprotocols.org/2024/1/e54180",
url="http://www.ncbi.nlm.nih.gov/pubmed/38709554"
}


@Article{info:doi/10.2196/49396,
author="Kinoshita, Shotaro
and Hanashiro, Sayaka
and Tsutsumi, Shiori
and Shiga, Kiko
and Kitazawa, Momoko
and Wada, Yasuyo
and Inaishi, Jun
and Kashiwagi, Kazuhiro
and Fukami, Toshikazu
and Mashimo, Yasumasa
and Minato, Kazumichi
and Kishimoto, Taishiro",
title="Assessment of Stress and Well-Being of Japanese Employees Using Wearable Devices for Sleep Monitoring Combined With Ecological Momentary Assessment: Pilot Observational Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="2",
volume="8",
pages="e49396",
keywords="wearable device",
keywords="sleep feedback",
keywords="well-being",
keywords="stress",
keywords="ecological momentary assessment",
keywords="feasibility study",
abstract="Background: Poor sleep quality can elevate stress levels and diminish overall well-being. Japanese individuals often experience sleep deprivation, and workers have high levels of stress. Nevertheless, research examining the connection between objective sleep assessments and stress levels, as well as overall well-being, among Japanese workers is lacking. Objective: This study aims to investigate the correlation between physiological data, including sleep duration and heart rate variability (HRV), objectively measured through wearable devices, and 3 states (sleepiness, mood, and energy) assessed through ecological momentary assessment (EMA) and use of rating scales for stress and well-being. Methods: A total of 40 office workers (female, 20/40, 50\%; mean age 40.4 years, SD 11.8 years) participated in the study. Participants were asked to wear a wearable wristband device for 8 consecutive weeks. EMA regarding sleepiness, mood, and energy levels was conducted via email messages sent by participants 4 times daily, with each session spaced 3 hours apart. This assessment occurred on 8 designated days within the 8-week timeframe. Participants' stress levels and perception of well-being were assessed using respective self-rating questionnaires. Subsequently, participants were categorized into quartiles based on their stress and well-being scores, and the sleep patterns and HRV indices recorded by the Fitbit Inspire 2 were compared among these groups. The Mann-Whitney U test was used to assess differences between the quartiles, with adjustments made for multiple comparisons using the Bonferroni correction. Furthermore, EMA results and the sleep and HRV indices were subjected to multilevel analysis for a comprehensive evaluation. Results: The EMA achieved a total response rate of 87.3\%, while the Fitbit Inspire 2 wear rate reached 88.0\%. When participants were grouped based on quartiles of well-being and stress-related scores, significant differences emerged. Specifically, individuals in the lowest stress quartile or highest subjective satisfaction quartile retired to bed earlier (P<.001 and P=.01, respectively), whereas those in the highest stress quartile exhibited greater variation in the midpoint of sleep (P<.001). A multilevel analysis unveiled notable relationships: intraindividual variability analysis indicated that higher energy levels were associated with lower deviation of heart rate during sleep on the preceding day ($\beta$=--.12, P<.001), and decreased sleepiness was observed on days following longer sleep durations ($\beta$=--.10, P<.001). Furthermore, interindividual variability analysis revealed that individuals with earlier midpoints of sleep tended to exhibit higher energy levels ($\beta$=--.26, P=.04). Conclusions: Increased sleep variabilities, characterized by unstable bedtime or midpoint of sleep, were correlated with elevated stress levels and diminished well-being. Conversely, improved sleep indices (eg, lower heart rate during sleep and earlier average bedtime) were associated with heightened daytime energy levels. Further research with a larger sample size using these methodologies, particularly focusing on specific phenomena such as social jet lag, has the potential to yield valuable insights. Trial Registration: UMIN-CTR UMIN000046858; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr\_view.cgi?recptno=R000053392 ",
doi="10.2196/49396",
url="https://formative.jmir.org/2024/1/e49396",
url="http://www.ncbi.nlm.nih.gov/pubmed/38696237"
}


@Article{info:doi/10.2196/55678,
author="Ferrer Costa, Jose
and Moran, Nuria
and Garcia Marti, Carlos
and Colmenares Hernandez, Javier Leomar
and Radu Ciorba Ciorba, Florin
and Ciudad, Jose Maria",
title="Immediate Impact of an 8-Week Virtual Reality Educational Program on Burnout and Work Engagement Among Health Care Professionals: Pre-Post Pilot Study",
journal="JMIR XR Spatial Comput",
year="2024",
month="Apr",
day="25",
volume="1",
pages="e55678",
keywords="virtual reality",
keywords="burnout",
keywords="mindfulness",
keywords="health care professionals",
keywords="mental health",
keywords="health promotion",
keywords="educational intervention",
abstract="Background: Health care professionals globally face increasing levels of burnout characterized by emotional exhaustion, depersonalization, and a reduced sense of accomplishment, and it has been notably exacerbated during the COVID-19 pandemic. This condition not only impacts the well-being of health care workers but also affects patient care and contributes to significant economic burden. Traditional approaches to mitigating burnout have included various psychosocial interventions, with mindfulness being recognized for its effectiveness in enhancing mental health and stress management. The emergence of virtual reality (VR) technology offers a novel immersive platform for delivering mindfulness and emotional management training. Objective: This study aimed to evaluate the immediate impact of an 8-week VR educational program on burnout and work engagement among health care professionals. Methods: This nonrandomized pre-post intervention study enrolled 90 health care professionals, including nurses, physicians, and allied health staff, from 3 different centers. Of these 90 professionals, 83 (92\%) completed the program. The intervention consisted of 8 weekly VR sessions of 10-13 minutes each, using Meta Quest 2 headsets. The sessions focused on mindfulness and emotional management. The Maslach Burnout Inventory (MBI) and Utrecht Work Engagement Scale (UWES) were used for assessments. Data analysis involved inferential statistical techniques for evaluating the impact on the scales, including paired t tests for normally distributed variables and Wilcoxon signed rank tests for nonnormally distributed variables. The significance of changes was indicated by P values <.05, with effect sizes measured using Cohen d for t tests and Cohen r for Wilcoxon tests for quantifying the magnitude of the intervention's effect. Results: The statistical analysis revealed significant improvements in the MBI and UWES indices after the intervention (P<.05). Specifically, the MBI showed reductions in emotional exhaustion (t82=5.58; P<.001; Cohen d=0.61) and depersonalization (t82=4.67; P<.001; Cohen d=0.51), and an increase in personal accomplishment (t82=?3.62; P<.001; Cohen d=0.4). The UWES revealed enhancements in vigor (t82=?3.77; P<.001; Cohen d=0.41), dedication (Z=?3.63; P<.001; Cohen r=0.41), and absorption (Z=?3.52; P<.001; Cohen r=0.4). Conclusions: The study provides initial data supporting the effectiveness of VR-based educational programs for reducing burnout and enhancing work engagement among health care professionals. While limitations, such as the absence of a control group, are acknowledged, the significant improvements in burnout and engagement indices coupled with high participant adherence and minimal VR discomfort underline the potential of VR interventions in health care settings. These encouraging findings pave the way for more comprehensive studies, including randomized controlled trials, to further validate and expand upon these results. ",
doi="10.2196/55678",
url="https://xr.jmir.org/2024/1/e55678"
}


@Article{info:doi/10.2196/51612,
author="Tremoulet, D. Patrice
and Lobo, F. Andrea
and Simmons, A. Christina
and Baliga, Ganesh
and Brady, Matthew",
title="Assessing the Usability and Feasibility of Digital Assistant Tools for Direct Support Professionals: Participatory Design and Pilot-Testing",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="25",
volume="11",
pages="e51612",
keywords="technology prototype",
keywords="data collection",
keywords="documentation",
keywords="direct support professionals",
keywords="intellectual and developmental disabilities",
keywords="pilot test",
keywords="mobile phone",
abstract="Background: The United States is experiencing a direct support professional (DSP) crisis, with demand far exceeding supply. Although generating documentation is a critical responsibility, it is one of the most wearisome aspects of DSPs' jobs. Technology that enables DSPs to log informal time-stamped notes throughout their shift could help reduce the burden of end-of-shift documentation and increase job satisfaction, which in turn could improve the quality of life of the individuals with intellectual and developmental disabilities (IDDs) whom DSPs support. However, DSPs, with varied ages, levels of education, and comfort using technology, are not likely to adopt tools that detract from caregiving responsibilities or increase workload; therefore, technological tools for them must be relatively simple, extremely intuitive, and provide highly valued capabilities. Objective: This paper describes the development and pilot-testing of a digital assistant tool (DAT) that enables DSPs to create informal notes throughout their shifts and use these notes to facilitate end-of-shift documentation. The purpose of the pilot study was to assess the usability and feasibility of the DAT. Methods: The research team applied an established user-centered participatory design process to design, develop, and test the DAT prototypes between May 2020 and April 2023. Pilot-testing entailed having 14 DSPs who support adults with IDDs use the first full implementation of the DAT prototypes during 2 or 3 successive work shifts and fill out demographic and usability questionnaires. Results: Participants used the DAT prototypes to create notes and help generate end-of-shift reports. The System Usability Scale score of 81.79 indicates that they found the prototypes easy to use. Survey responses imply that using the DAT made it easier for participants to produce required documentation and suggest that they would adopt the DAT if this tool were available for daily use. Conclusions: Simple technologies such as the DAT prototypes, which enable DSPs to use mobile devices to log time-stamped notes throughout their shift with minimal effort and use the notes to help write reports, have the potential to both reduce the burden associated with producing documentation and enhance the quality (level of detail and accuracy) of this documentation. This could help to increase job satisfaction and reduce turnover in DSPs, both of which would help improve the quality of life of the individuals with IDDs whom they support. The pilot test results indicate that DSPs found the DAT easy to use. Next steps include (1) producing more robust versions of the DAT with additional capabilities, such as storing data locally on mobile devices when Wi-Fi is not available; and (2) eliciting input from agency directors, families, and others who use data about adults with IDDs to help care for them to ensure that data produced by DSPs are relevant and useful. ",
doi="10.2196/51612",
url="https://humanfactors.jmir.org/2024/1/e51612",
url="http://www.ncbi.nlm.nih.gov/pubmed/38662420"
}


@Article{info:doi/10.2196/51791,
author="Lam, T. Lawrence
and Lam, P. Mary K.",
title="A Web-Based and Mobile Intervention Program Using a Spaced Education Approach for Workplace Mental Health Literacy: Cluster Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2024",
month="Apr",
day="23",
volume="11",
pages="e51791",
keywords="mHealth",
keywords="web-based intervention",
keywords="mental health literacy",
keywords="psychoeducation",
keywords="randomized controlled trial",
keywords="workplace",
keywords="performance",
keywords="worker",
keywords="intervention",
keywords="digital health",
keywords="mental wellness",
keywords="promote",
keywords="well-being",
keywords="mobile health",
keywords="technology",
abstract="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. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000464167; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377176 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3748-y ",
doi="10.2196/51791",
url="https://mental.jmir.org/2024/1/e51791"
}


@Article{info:doi/10.2196/57422,
author="Arguello, Diego",
title="Authors' Reply: Ambiguity in Statistical Analysis Methods and Nonconformity With Prespecified Commitment to Data Sharing in a Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="3",
volume="26",
pages="e57422",
keywords="prolonged sedentary behavior",
keywords="sedentary behavior",
keywords="sit-to-stand desks",
keywords="treadmill desks",
keywords="physical activity promotion",
keywords="workplace wellness",
keywords="seated office workers",
keywords="move more and sit less",
doi="10.2196/57422",
url="https://www.jmir.org/2024/1/e57422",
url="http://www.ncbi.nlm.nih.gov/pubmed/38568734"
}


@Article{info:doi/10.2196/54090,
author="Jamshidi-Naeini, Yasaman
and Golzarri-Arroyo, Lilian
and Thapa, K. Deependra
and Brown, W. Andrew
and Kpormegbey, E. Daniel
and Allison, B. David",
title="Ambiguity in Statistical Analysis Methods and Nonconformity With Prespecified Commitment to Data Sharing in a Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="3",
volume="26",
pages="e54090",
keywords="cluster randomized trial",
keywords="clustering",
keywords="nesting",
keywords="data availability",
keywords="random allocation",
keywords="data sharing",
keywords="reproducibility",
doi="10.2196/54090",
url="https://www.jmir.org/2024/1/e54090",
url="http://www.ncbi.nlm.nih.gov/pubmed/38568721"
}


@Article{info:doi/10.2196/49218,
author="Chamot, Sylvain
and Mahieu, Isabelle
and Delzard, Marion
and Leroy, L{\'e}a
and Marhic, Gwen
and Gignon, Maxime",
title="Using a Virtual Reality Tool to Provide Primary Prevention Training in the Construction Field Following a Periodic Medical Visit: Cross-Sectional Study",
journal="JMIR Serious Games",
year="2024",
month="Mar",
day="15",
volume="12",
pages="e49218",
keywords="virtual reality",
keywords="virtual training tool",
keywords="prevention",
keywords="occupational medicine",
keywords="construction",
abstract="Background: The construction field is highly concerned with the risk of work-related accidents, and training employees is difficult due to their small numbers in most companies. Objective: This study aimed to study the impact of a virtual reality (VR) training tool following a periodic occupational health medical visit on the feeling of personal effectiveness in preventing occupational risks related to co-activity on a construction site. Methods: We conducted a cross-sectional study with employees who had a periodic medical visit between April 1, 2022, and October 13, 2022, in a French occupational health service specializing in the construction field (Services M{\'e}dicaux Interentreprises B{\^a}timent Travaux Publics [SMIBTP]). The employees were divided into 2 groups according to the training received: a medical visit alone or coupled with a session with a VR tool. We compared the scores for a ``feeling of self-efficacy in occupational risk prevention'' using the Fisher exact test. Results: Of the 588 employees included, 210 had a medical visit alone, and 378 had a medical visit coupled with VR training. Training with the VR tool was associated with an increased ``feeling of self-efficacy in occupational risk prevention.'' The employees who benefited from the training reported a willingness to apply the advice given on prevention to a greater extent than those who did not, and they believed that risks on the worksite could be reduced using this tool. Conclusions: Using VR training as a complement to periodic medical visits in an occupational health service improves the feeling of personal effectiveness in occupational risk prevention at the end of the training. If this trend is confirmed over a longer period of time, it could be an easily accessible prevention lever for employees in the future. ",
doi="10.2196/49218",
url="https://games.jmir.org/2024/1/e49218",
url="http://www.ncbi.nlm.nih.gov/pubmed/38488851"
}


@Article{info:doi/10.2196/43875,
author="Elliott, Mary
and Khallouf, Camille
and Hirsch, Jennifer
and de Camps Meschino, Diane
and Zamir, Orit
and Ravitz, Paula",
title="Novel Web-Based Drop-In Mindfulness Sessions (Pause-4-Providers) to Enhance Well-Being Among Health Care Workers During the COVID-19 Pandemic: Descriptive and Qualitative Study",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="14",
volume="8",
pages="e43875",
keywords="COVID-19",
keywords="pandemic",
keywords="health care worker",
keywords="resilience",
keywords="mental health",
keywords="burnout",
keywords="well-being",
keywords="mindfulness meditation",
keywords="web-based group",
keywords="drop-in",
keywords="mindfulness",
keywords="health care staff",
keywords="meditation",
keywords="worker",
keywords="job",
keywords="occupational health",
abstract="Background: The COVID-19 pandemic exerted extraordinary pressure on health care workers (HCWs), imperiling their well-being and mental health. In response to the urgent demand to provide barrier-free support for the health care workforce, Pause-4-Providers implemented 30-minute live web-based drop-in mindfulness sessions for HCWs. Objective: This study aims to evaluate the use, feasibility, satisfaction, and acceptability of a novel mindfulness program aimed at enhancing the well-being of HCWs during the COVID-19 pandemic. Methods: Accrual for the study continued throughout the first 3 pandemic waves, and attendees of ?1 session were invited to participate. The evaluation framework included descriptive characteristics, including participant demographics, resilience at work, and single-item burnout scores; feedback questionnaires on reasons attended, benefits, and satisfaction; qualitative interviews to further understand participant experience, satisfaction, benefits, enablers, and barriers; and the number of participants in each session summarized according to the pandemic wave. Results: We collected descriptive statistics from 50 consenting HCWs. Approximately half of the participants (24/50, 48\%) attended >1 session. The study participants were predominantly female individuals (40/50, 80\%) and comprised physicians (17/50, 34\%), nurses (9/50, 18\%), and other HCWs (24/50, 48\%), who were largely from Ontario (41/50, 82\%). Of 50 attendees, 26 (52\%) endorsed feeling burned out. The highest attendance was in May 2020 and January 2021, corresponding to the first and second pandemic waves. The participants endorsed high levels of satisfaction (43/47, 92\%). The most cited reasons for attending the program were to relax (38/48, 79\%), manage stress or anxiety (36/48, 75\%), wish for loving kindness or self-compassion (30/48, 64\%), learn mindfulness (30/48, 64\%), and seek help with emotional reactivity (25/48, 53\%). Qualitative interviews with 15 out of 50 (30\%) participants identified positive personal and professional impacts. Personal impacts revealed that participation helped HCWs to relax, manage stress, care for themselves, sleep better, reduce isolation, and feel recognized. Professional impacts included having a toolbox of mindfulness techniques, using mindfulness moments, and being calmer at work. Some participants noted that they shared techniques with their colleagues. The reported barriers included participants' needing time to prioritize themselves, fatigue, forgetting to apply skills on the job, and finding a private place to participate. Conclusions: The Pause-4-Providers participants reported that the web-based groups were accessible; appreciated the format, content, and faculty; and had high levels of satisfaction with the program. Both novel format (eg, drop-in, live, web-based, anonymous, brief, and shared activity with other HCWs) and content (eg, themed mindfulness practices including micropractices, with workplace applications) were enablers to participation. This study of HCW support sessions was limited by the low number of consenting participants and the rolling enrollment project design; however, the findings suggest that a drop-in web-based mindfulness program has the potential to support the well-being of HCWs. ",
doi="10.2196/43875",
url="https://formative.jmir.org/2024/1/e43875",
url="http://www.ncbi.nlm.nih.gov/pubmed/38180869"
}


@Article{info:doi/10.2196/48883,
author="Demirel, Sevda
and Roke, Yvette
and Hoogendoorn, W. Adriaan
and Hoefakker, Jamie
and Hoeberichts, Kirsten
and van Harten, N. Peter",
title="Assessing the Effectiveness of STAPP@Work, a Self-Management Mobile App, in Reducing Work Stress and Preventing Burnout: Single-Case Experimental Design Study",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="29",
volume="26",
pages="e48883",
keywords="mental health",
keywords="stress",
keywords="coping",
keywords="burnout",
keywords="stress management",
keywords="digital intervention",
keywords="health promotion",
keywords="mobile apps",
keywords="mobile health",
keywords="mHealth",
keywords="mental health professionals",
abstract="Background: Work-related stress and burnout remain common problems among employees, leading to impaired health and higher absenteeism. The use of mobile health apps to promote well-being has grown substantially; however, the impact of such apps on reducing stress and preventing burnout is limited. Objective: This study aims to assess the effectiveness of STAPP@Work, a mobile-based stress management intervention, on perceived stress, coping self-efficacy, and the level of burnout among mental health employees. Methods: The study used a single-case experimental design to examine the use of STAPP@Work among mental health employees without a known diagnosis of burnout (N=63). Participants used the app for 1 week per month repeatedly for a period of 6 months. Using a reversal design, the participants used the app 6 times to assess replicated immediate (1 week after use) and lasting (3 weeks after use) effects. The Perceived Stress Scale, the Coping Self-Efficacy Scale, and the Burnout Assessment Tool were used to measure the outcomes. Linear mixed models were used to analyze the data. Results: After 6 months of app use for 1 week per month, the participants showed a statistically significant decrease in perceived stress (b=--0.38, 95\% CI --0.67 to --0.09; P=.01; Cohen d=0.50) and burnout symptoms (b=--0.31, 95\% CI --0.51 to --0.12; P=.002; Cohen d=0.63) as well as a statistically significant improvement in problem-focused coping self-efficacy (b=0.42, 95\% CI 0-0.85; P=.049; Cohen d=0.42). Long-term use of the app provided consistent reductions in burnout symptoms over time, including in the level of exhaustion and emotional impairment. Conclusions: The use of an app-based stress management intervention has been shown to reduce burnout symptoms and enhance coping self-efficacy among mental health workers. Prevention of burnout and minimization of work-related stress are of utmost importance to protect employee health and reduce absenteeism. ",
doi="10.2196/48883",
url="https://www.jmir.org/2024/1/e48883",
url="http://www.ncbi.nlm.nih.gov/pubmed/38275128"
}


@Article{info:doi/10.2196/47458,
author="Patel, Priya
and Brown, Susan
and Guo, Boliang
and Holmes, A. Emily
and Iyadurai, Lalitha
and Kingslake, Jonathan
and Highfield, Julie
and Morriss, Richard",
title="Using a Novel Gameplay Intervention to Target Intrusive Memories After Work-Related Trauma: Iterative Qualitative Analysis of Intensive Care Unit Staff Experiences",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="29",
volume="8",
pages="e47458",
keywords="intensive care",
keywords="posttraumatic stress disorder",
keywords="PTSD",
keywords="qualitative research",
keywords="intervention study",
keywords="health care professionals",
keywords="digital intervention",
keywords="staff well-being",
keywords="pandemic",
keywords="intrusive memories",
keywords="work-related trauma",
keywords="mobile phone",
abstract="Background: Many intensive care unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population; however, factors such as mental health stigma and difficulty in fitting interventions into busy schedules can pose barriers. The Brief Gameplay Intervention For National Health Service Intensive Care Unit Staff Affected By COVID-19 Trauma (GAINS) study tested a brief, digital imagery-competing task intervention (including computer gameplay) with the aim of reducing the recurrence of intrusive memories, which holds promise for overcoming some of these barriers. Objective: This substudy aims to explore barriers and facilitators to the uptake and practical use of the intervention by ICU staff, along with its acceptability, and iteratively explore the impact of intervention optimizations to further refine the intervention. Methods: The GAINS study is a randomized controlled trial comparing access to a brief digital imagery-competing task intervention for 4 weeks with usual care followed by delayed access to the intervention. The participants were ICU staff who worked during the COVID-19 pandemic and experienced intrusive memories. All participants were sent a questionnaire at 4 weeks to gather data about intervention acceptability. Nested within the randomized controlled trial, a subset of 16 participants was interviewed, and data were analyzed using thematic analysis drawing from a framework approach. Results: Both quantitative and qualitative data indicated high acceptability of the intervention. Intervention use data show that, on average, staff were able to target approximately 73\% (3.64/4.88) of their intrusive memories and engaged with the Tetris component for the full 20 minutes per session. Overall, on the acceptability questionnaire, staff found the intervention easy to use, helpful, and highly acceptable. The interviews generated four themes: approach to the intervention, positives of the intervention, negatives of the intervention, and improvements and optimizations. Findings highlighted barriers that ICU staff experienced: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, and skepticism. However, they provided suggestions on how barriers could be overcome and discussed the advantages of the intervention when compared with other treatments. Although participants described many positive aspects of the intervention, such as being easy to use, enjoyable, and leading to a reduction in the frequency or intensity of intrusive memories, they also raised practical issues for implementation. Conclusions: The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events among ICU staff. Further refinement is needed to improve the adoption and reach of this intervention. A limitation is that we could not interview the National Health Service staff who were unable or unwilling to take part in the trial. ",
doi="10.2196/47458",
url="https://formative.jmir.org/2024/1/e47458",
url="http://www.ncbi.nlm.nih.gov/pubmed/38421698"
}


@Article{info:doi/10.2196/47181,
author="Locke, Sean
and Osborne, Jenna",
title="Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="14",
volume="8",
pages="e47181",
keywords="mobile health",
keywords="mHealth",
keywords="behavior change",
keywords="stress management",
keywords="intervention",
keywords="pilot study",
keywords="heart rate variability",
keywords="health coaching",
keywords="coach",
keywords="coaching",
keywords="coaches",
keywords="work-related stress",
keywords="stress",
keywords="wellness",
keywords="burnout",
keywords="behavioral intervention",
keywords="work",
keywords="worker",
keywords="workers",
keywords="employee",
keywords="employees",
keywords="occupational health",
keywords="job",
keywords="satisfaction",
keywords="web-based",
keywords="remote",
keywords="corporate",
keywords="web analytics",
keywords="biofeedback",
keywords="survey",
keywords="surveys",
keywords="interview",
keywords="interviews",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="acceptance",
abstract="Background: Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy. Objective: This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase. Methods: The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2{\texttimes}2{\texttimes}2{\texttimes}2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes. Results: Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75\% (12/16) participant retention and 67\% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model. Conclusions: The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner. ",
doi="10.2196/47181",
url="https://formative.jmir.org/2024/1/e47181",
url="http://www.ncbi.nlm.nih.gov/pubmed/38354036"
}


@Article{info:doi/10.2196/47308,
author="Rutter, Sophie
and Sanger, Sally
and Madden, D. Andrew
and Ehdeed, Sukaina
and Stones, Catherine",
title="Office Workers' Views About the Uses, Concerns, and Acceptance of Hand Hygiene Data Collected From Smart Sanitizers: Exploratory Qualitative Interview Study",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="11",
volume="8",
pages="e47308",
keywords="hand hygiene",
keywords="smart sanitizers",
keywords="Internet of Things",
keywords="IoT",
keywords="offices",
keywords="workplaces",
keywords="smart systems",
abstract="Background: COVID-19 and the prospect of future pandemics have emphasized the need to reduce disease transmission in workplaces. Despite the well-established link between good hand hygiene (HH) and employee health, HH in nonclinical workplaces has received little attention. Smart sanitizers have been deployed in clinical settings to motivate and enforce HH. This study is part of a large project that explores the potential of smart sanitizers in office settings. Objective: Our previous study found that for office workers to accept the deployment of smart sanitizers, they would need to find the data generated as useful and actionable. The objectives of this study were to identify (1) the potential uses and actions that could be taken from HH data collected by smart sanitizers (2) the concerns of office workers for the identified uses and actions and (3) the circumstances in which office workers accept HH monitoring. Methods: An interview study was conducted with 18 office workers from various professions. Interview questions were developed using a framework from personal informatics. Transcripts were analyzed thematically. Results: A wide range of uses of smart sanitizer data was identified including managing hygiene resources and workflows, finding operating sanitizers, communicating the (high) standard of organizational hygiene, promoting and enforcing organizational hygiene policies, improving workers' own hygiene practices, executing more effective interventions, and identifying the causes of outbreaks. However, hygiene is mostly considered as a private matter, and it is also possible that no action would be taken. Office workers were also concerned about bullying, coercion, and use of hygiene data for unintended purposes. They were also worried that the data could be inaccurate or incomplete, leading to misrepresentation of hygiene practices. Office workers suggested that they would be more likely to accept monitoring in situations where hygiene is considered important, when there are clear benefits to data collection, if their privacy is respected, if they have some control over how their data are collected, and if the ways in which the data will be used are clearly communicated. Conclusions: Smart sanitizers could have a valuable role in improving hygiene practices in offices and reducing disease transmission. Many actionable uses for data collected from smart systems were identified. However, office workers consider HH as a personal matter, and acceptance of smart systems is likely to be dynamic and will depend on the broad situation. Except when there are disease outbreaks, smart systems may need to be restricted to uses that do not require the sharing of personal data. Should organizations wish to implement smart sanitizers in offices, it would be advisable to consult widely with staff and develop systems that are customizable and personalizable. ",
doi="10.2196/47308",
url="https://formative.jmir.org/2024/1/e47308",
url="http://www.ncbi.nlm.nih.gov/pubmed/38206674"
}


@Article{info:doi/10.2196/48834,
author="Chen, Hung-Hsun
and Lu, Horng-Shing Henry
and Weng, Wei-Hung
and Lin, Yu-Hsuan",
title="Developing a Machine Learning Algorithm to Predict the Probability of Medical Staff Work Mode Using Human-Smartphone Interaction Patterns: Algorithm Development and Validation Study",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="29",
volume="25",
pages="e48834",
keywords="human-smartphone interaction",
keywords="digital phenotyping",
keywords="work hours",
keywords="machine learning",
keywords="deep learning",
keywords="probability in work mode",
keywords="one-dimensional convolutional neural network",
keywords="extreme gradient-boosted trees",
abstract="Background: Traditional methods for investigating work hours rely on an employee's physical presence at the worksite. However, accurately identifying break times at the worksite and distinguishing remote work outside the worksite poses challenges in work hour estimations. Machine learning has the potential to differentiate between human-smartphone interactions at work and off work. Objective: In this study, we aimed to develop a novel approach called ``probability in work mode,'' which leverages human-smartphone interaction patterns and corresponding GPS location data to estimate work hours. Methods: To capture human-smartphone interactions and GPS locations, we used the ``Staff Hours'' app, developed by our team, to passively and continuously record participants' screen events, including timestamps of notifications, screen on or off occurrences, and app usage patterns. Extreme gradient boosted trees were used to transform these interaction patterns into a probability, while 1-dimensional convolutional neural networks generated successive probabilities based on previous sequence probabilities. The resulting probability in work mode allowed us to discern periods of office work, off-work, breaks at the worksite, and remote work. Results: Our study included 121 participants, contributing to a total of 5503 person-days (person-days represent the cumulative number of days across all participants on which data were collected and analyzed). The developed machine learning model exhibited an average prediction performance, measured by the area under the receiver operating characteristic curve, of 0.915 (SD 0.064). Work hours estimated using the probability in work mode (higher than 0.5) were significantly longer (mean 11.2, SD 2.8 hours per day) than the GPS-defined counterparts (mean 10.2, SD 2.3 hours per day; P<.001). This discrepancy was attributed to the higher remote work time of 111.6 (SD 106.4) minutes compared to the break time of 54.7 (SD 74.5) minutes. Conclusions: Our novel approach, the probability in work mode, harnessed human-smartphone interaction patterns and machine learning models to enhance the precision and accuracy of work hour investigation. By integrating human-smartphone interactions and GPS data, our method provides valuable insights into work patterns, including remote work and breaks, offering potential applications in optimizing work productivity and well-being. ",
doi="10.2196/48834",
url="https://www.jmir.org/2023/1/e48834",
url="http://www.ncbi.nlm.nih.gov/pubmed/38157232"
}


@Article{info:doi/10.2196/42510,
author="Althammer, Elena Sarah
and W{\"o}hrmann, Marit Anne
and Michel, Alexandra",
title="Comparing Web-Based and Blended Training for Coping With Challenges of Flexible Work Designs: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="19",
volume="25",
pages="e42510",
keywords="blended training",
keywords="web-based training",
keywords="psychological detachment",
keywords="well-being",
keywords="work-life balance",
abstract="Background: Workers with flexible work designs (FWDs) face specific challenges, such as difficulties in detaching from work, setting boundaries between work and private life, and recovering from work. Objective: This study evaluated the effectiveness of an intervention in improving the recovery, work-life balance, and well-being of workers with FWDs compared with a waitlist control group. It also compares the effectiveness of a web-based training format and blended training format. Methods: In the web-based training format, participants individually completed 6 web-based modules and daily tasks over 6 weeks, learning self-regulation strategies to meet the particular challenges of FWDs. In the blended training format, participants attended 3 group sessions in addition to completing the 6 web-based modules. In a randomized controlled trial, participants were assigned to a web-based intervention group (196/575, 34.1\%), blended intervention group (198/575, 34.4\%), or waitlist control group (181/575, 31.5\%). Study participants self-assessed their levels of primary outcomes (psychological detachment, satisfaction with work-life balance, and well-being) before the intervention, after the intervention, at a 4-week follow-up, and at a 6-month follow-up. The final sample included 373 participants (web-based intervention group: n=107, 28.7\%; blended intervention group: n=129, 34.6\%; and control group: n=137, 36.7\%). Compliance was assessed as a secondary outcome. Results: The results of multilevel analyses were in line with our hypothesis that both training formats would improve psychological detachment, satisfaction with work-life balance, and well-being. We expected blended training to reinforce these effects, but blended training participants did not profit more from the intervention than web-based training participants. However, they reported to have had more social exchange, and blended training participants were more likely to adhere to the training. Conclusions: Both web-based and blended training are effective tools for improving the recovery, work-life balance, and well-being of workers with FWDs. Group sessions can increase the likelihood of participants actively participating in web-based modules and exercises. Trial Registration: German Clinical Trials Register DRKS00032721; https://drks.de/search/en/trial/DRKS00032721 ",
doi="10.2196/42510",
url="https://www.jmir.org/2023/1/e42510",
url="http://www.ncbi.nlm.nih.gov/pubmed/38113084"
}


@Article{info:doi/10.2196/52088,
author="Turesson, Christina
and Liedberg, Gunilla
and Bj{\"o}rk, Mathilda",
title="Evaluating the Clinical Use and Utility of a Digital Support App for Employees With Chronic Pain Returning to Work (SWEPPE): Observational Study",
journal="JMIR Hum Factors",
year="2023",
month="Dec",
day="11",
volume="10",
pages="e52088",
keywords="chronic pain",
keywords="digital support",
keywords="eHealth",
keywords="return-to-work",
keywords="user data",
keywords="mobile phone",
abstract="Background: The digital app SWEPPE (sustainable worker, a digital support for persons with chronic pain and their employers) was developed to improve the support of people with chronic pain in their return-to-work process after sick leave and includes functions such as the action plan, daily self-rating, self-monitoring graphs, the coach, the library, and shared information with the employer. Objective: This study aims to describe the use of the smartphone app SWEPPE among people with chronic pain who have participated in an interdisciplinary pain rehabilitation program. Methods: This is a case study including 16 people participating in a feasibility study. The analyses were based on user data collected for 3 months. Quantitative data regarding used functions were analyzed with descriptive statistics, and qualitative data of identified needs of support from the employer were grouped into 8 categories. Results: Self-monitoring was used by all participants (median 26, IQR 8-87 daily registrations). A total of 11 (N=16, 69\%) participants set a work-related goal and performed weekly evaluations of goal fulfillment and ratings of their work ability. In total, 9 (56\%) participants shared information with their employer and 2 contacted the coach. A total of 15 (94\%) participants identified a total of 51 support interventions from their employer. Support to adapt to work assignments and support to adapt to work posture were the 2 biggest categories. The most common type of support identified by 53\% (8/15) of the participants was the opportunity to take breaks and short rests. Conclusions: Participants used multiple SWEPPE functions, such as daily self-registration, goal setting, self-monitoring, and employer support identification. This shows the flexible nature of SWEPPE, enabling individuals to select functions that align with their needs. Additional research is required to investigate the extended use of SWEPPE and how employers use shared employee information. ",
doi="10.2196/52088",
url="https://humanfactors.jmir.org/2023/1/e52088",
url="http://www.ncbi.nlm.nih.gov/pubmed/38079212"
}


@Article{info:doi/10.2196/45177,
author="Richardson, X. Matt
and Aytar, Osman
and Hess-Wiktor, Katarzyna
and Wamala-Andersson, Sarah",
title="Digital Microlearning for Training and Competency Development of Older Adult Care Personnel: Mixed Methods Intervention Study to Assess Needs, Effectiveness, and Areas of Application",
journal="JMIR Med Educ",
year="2023",
month="Dec",
day="4",
volume="9",
pages="e45177",
keywords="digital microlearning",
keywords="elderly care",
keywords="older adult care",
keywords="competency development",
keywords="implementation research",
keywords="dementia",
keywords="COVID-19",
abstract="Background: Older adult care organizations face challenges today due to high personnel turnover and pandemic-related obstacles in conducting training and competence development programs in a time-sensitive and fit-for-purpose manner. Digital microlearning is a method that attempts to meet these challenges by more quickly adapting to the educational needs of organizations and individual employees in terms of time, place, urgency, and retention capacity more than the traditional competency development methods. Objective: This study aimed to determine if and how an app-based digital microlearning intervention can meet older adult care organizations' personnel competency development needs in terms of knowledge retention and work performance. Methods: This study assessed the use of a digital microlearning app, which was at the testing stage in the design thinking model among managerial (n=4) and operational (n=22) employees within 3 older adult care organizations. The app was used to conduct predetermined competency development courses for the staff. Baseline measurements included participants' previous training and competency development methods and participation, as well as perceived needs in terms of time, design, and channel. They then were introduced to and used a digital microlearning app to conduct 2 courses on one or more digital devices, schedules, and locations of their own choice during a period of {\textasciitilde}1 month. The digital app and course content, perceived knowledge retention, and work performance and satisfaction were individually assessed via survey upon completion. The survey was complemented with 4 semistructured focus group interviews, which allowed participants (in total 16 individuals: 6 managerial-administrative employees and 10 operational employees) to describe their experiences with the app and its potential usefulness within their organizations. Results: The proposed advantages of the digital microlearning app were largely confirmed by the participants' perceptions, particularly regarding the ease of use and accessibility, and efficiency and timeliness of knowledge delivery. Assessments were more positive among younger or less experienced employees with more diverse backgrounds. Participants expressed a positive inclination toward using the app, and suggestions provided regarding its potential development and broader use suggested a positive view of digitalization in general. Conclusions: Our results show that app-based digital microlearning appears to be an appropriate new method for providing personnel competency development within the older adult care setting. Its implementation in a larger sample can potentially provide more detailed insights regarding its intended effects. ",
doi="10.2196/45177",
url="https://mededu.jmir.org/2023/1/e45177",
url="http://www.ncbi.nlm.nih.gov/pubmed/38048152"
}


@Article{info:doi/10.2196/51549,
author="Lu, Yan'e
and Li, Yang
and Huang, Yongqi
and Zhang, Xuan
and Wang, Juan
and Wu, Liuliu
and Cao, Fenglin",
title="Effects and Mechanisms of a Web- and Mobile-Based Acceptance and Commitment Therapy Intervention for Anxiety and Depression Symptoms in Nurses: Fully Decentralized Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="27",
volume="25",
pages="e51549",
keywords="acceptance and commitment therapy",
keywords="anxiety",
keywords="depression",
keywords="internet-based intervention",
keywords="nurse",
keywords="randomized controlled trial",
abstract="Background: Acceptance and commitment therapy (ACT) is a promising intervention for improving mental health. However, there is limited evidence on its effectiveness for nurses, particularly in web- and mobile-based intervention forms, in mitigating anxiety and depression symptoms. Objective: In this study, we aimed to examine the effect and underlying psychological mechanisms of a web- and mobile-based ACT intervention on nurses' anxiety and depression symptoms. Methods: In this fully decentralized randomized controlled trial, nurses were recruited nationwide across China through advertisements and posters. They were randomly assigned to either the 5-week fully automated intervention or the waiting group. Primary outcomes (anxiety and depression symptoms); secondary outcomes (sleep quality, burnout, and work performance); and mediators (psychological flexibility, cognitive defusion, mindfulness, and values) were assessed using the Wenjuanxing platform. Data collectors were blinded to the group assignments throughout the study period. Results: A total of 145 nurses with anxiety or depression symptoms were randomly assigned to either the intervention group (n=72, 49.7\%) or the control group (n=73, 50.3\%); 97.2\% (n=141) were female. During the study, 36 (24.8\%) nurses were lost to follow-up, and 53 (73.6\%) completed the entire intervention. Nurses in the intervention group showed significant improvement in anxiety (d=0.67, 95\% CI 0.33-1.00) and depression symptoms (d=0.58, 95\% CI 0.25-0.91), and the effects were sustained for 3 months after the intervention (anxiety: d=0.55, 95\% CI 0.22-0.89; depression: d=0.66, 95\% CI 0.33-1.00). Changes in psychological flexibility, cognitive defusion, and values mediated the effect of the intervention on anxiety and depression symptoms, while mindfulness did not have a mediating effect. Conclusions: The web- and mobile-based ACT intervention used in this study significantly improved nurses' anxiety and depression symptoms by improving psychological flexibility, cognitive defusion, and values. The results provide new ideas for hospital administrators to prevent and intervene in nurses' psychological issues. Trial Registration: Chinese Clinical Trial Register ChiCTR2200059218; https://tinyurl.com/4mb4t5y9 ",
doi="10.2196/51549",
url="https://www.jmir.org/2023/1/e51549",
url="http://www.ncbi.nlm.nih.gov/pubmed/38010787"
}


@Article{info:doi/10.2196/45200,
author="Vuohijoki, Anni
and Huusko, Mira
and Ristolainen, Leena
and Hakasaari, Pipsa
and Kautiainen, Hannu
and Leppilahti, Juhana
and Kivivuori, Sanna-Maria
and Hurri, Heikki",
title="The Effects of Quality Assurance System Implementation on Work Well-Being and Patient Safety: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="23",
volume="12",
pages="e45200",
keywords="Joint Commission International",
keywords="health and safety",
keywords="JCI",
keywords="human resource management",
keywords="organizational development",
keywords="quality in health care",
abstract="Background: Systematic monitoring of work atmosphere and patient safety incidents is a necessary part of a quality assurance system, particularly an accredited system like the Joint Commission International (JCI). How the implementation of quality assurance systems affects well-being at work and patient safety is unclear. Evidence shows that accreditation improves workplace atmosphere and well-being. Thus, the assumption that an increase in employees' well-being at work improves patient safety is reasonable. Objective: This study aims to describe the protocol for monitoring the effects of implementing the quality assurance system of JCI at Orton Orthopedic Hospital on employees' well-being (primary outcome) and patient safety (secondary outcome). Methods: Quantitative (questionnaires and register data) and qualitative (semistructured interviews) methods will be used. In addition, quantitative data will be collected from register data. Both quantitative and register data will be analyzed. Register data analysis will be performed using generalized linear models with an appropriate distribution and link function. The study timeline covers the time before, during, and after the start of the accreditation process. The collected data will be used to compare job satisfaction, as a part of the well-being questionnaire, and the development of patient safety during the accreditation process. Results: The results of the quality assurance system implementation illuminate its possible effects on the patient's safety and job satisfaction. The repeatability and internal consistency reliability of the well-being questionnaire will be reported. Data collection will begin in May, 2024. It will be followed by data analysis and the results are expected to be published by 2025. Conclusions: The planned study will contribute to the evaluation of the effects of JCI accreditation in terms of well-being at work and patient safety. International Registered Report Identifier (IRRID): PRR1-10.2196/45200 ",
doi="10.2196/45200",
url="https://www.researchprotocols.org/2023/1/e45200",
url="http://www.ncbi.nlm.nih.gov/pubmed/37995119"
}


@Article{info:doi/10.2196/47377,
author="Veronesi, Giovanni
and Ferrario, Mario Marco
and Giusti, Maria Emanuele
and Borchini, Rossana
and Cimmino, Lisa
and Ghelli, Monica
and Banfi, Alberto
and Luoni, Alessandro
and Persechino, Benedetta
and Di Tecco, Cristina
and Ronchetti, Matteo
and Gianfagna, Francesco
and De Matteis, Sara
and Castelnuovo, Gianluca
and Iacoviello, Licia",
title="Systematic Violence Monitoring to Reduce Underreporting and to Better Inform Workplace Violence Prevention Among Health Care Workers: Before-and-After Prospective Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Nov",
day="13",
volume="9",
pages="e47377",
keywords="workplace",
keywords="work",
keywords="workers",
keywords="worker",
keywords="occupational health",
keywords="safety",
keywords="report",
keywords="reporting",
keywords="incident",
keywords="abuse",
keywords="health care workers",
keywords="HCW",
keywords="violence",
keywords="surveillance",
keywords="underreporting",
keywords="risk",
keywords="guidelines",
keywords="incident report",
keywords="Italy",
keywords="prevention",
keywords="workplace violence",
keywords="hospital setting",
keywords="assault",
keywords="physical assaults",
keywords="mental health",
keywords="risk management",
abstract="Background: Monitoring workplace violence (WPV) against health care workers (HCWs) through incident reporting is crucial to drive prevention, but the actual implementation is spotty and experiences underreporting. Objective: This study aims to introduce a systematic WPV surveillance in 2 public referral hospitals in Italy and assess underreporting, WPV annual rates, and attributes ``before'' (2016-2020) and ``after'' its implementation (November 2021 to 2022). Methods: During 2016-2020, incident reporting was based on procedures and data collection forms that were neither standardized between hospitals nor specific for aggressions. We planned and implemented a standardized WPV surveillance based on (1) an incident report form for immediate and systematic event notification, adopting international standards for violence definitions; (2) second-level root cause analysis with a dedicated psychologist, assessing violence determinants and impacts and offering psychological counseling; (3) a web-based platform for centralized data collection; and (4) periodic training for workforce coordinators and newly hired workers. We used data from incident reports to estimate underreporting, defined as an observed-to-expected (from literature and the ``before'' period) WPV ratio less than 1, and the 12-month WPV rates (per 100 HCWs) in the ``before'' and ``after'' periods. During the latter period, we separately estimated WPV rates for first and recurrent events. Results: In the ``before'' period, the yearly observed-to-expected ratios were consistently below 1 and as low as 0.27, suggesting substantial violence underreporting of up to 73\%. WPV annual rates declined in 1 hospital (from 1.92 in 2016 to 0.57 in 2020) and rose in the other (from 0.52 to 1.0), with the divergence being attributable to trends in underreporting. Available data were poorly informative to identify at-risk HCW subgroups. In the ``after'' period, the observed-to-expected ratio rose to 1.14 compared to literature and 1.91 compared to the ``before'' period, consistently in both hospitals. The 12-month WPV rate was 2.08 (95\% CI 1.79-2.42; 1.52 and 2.35 in the 2 hospitals); one-fifth (0.41/2.08, 19.7\%) was due to recurrences. Among HCWs, the youngest group (3.79; P<.001), nurses (3.19; P<.001), and male HCWs (2.62; P=.008) reported the highest rates. Emergency departments and psychiatric wards were the 2 areas at increased risk. Physical assaults were more likely in male than female HWCs (45/67, 67.2\% vs 62/130, 47.7\%; P=.01), but the latter experienced more mental health consequences (46/130, 35.4\% vs 13/67, 19.4\%; P=.02). Overall, 40.8\% (53/130) of female HWCs recognized sociocultural (eg, linguistic or cultural) barriers as contributing factors for the aggression, and 30.8\% (40/130) of WPV against female HCWs involved visitors as perpetrators. Conclusions: A systematic WPV surveillance reduced underreporting. The identification of high-risk workers and characterization of violence patterns and attributes can better inform priorities and contents of preventive policies. Our evaluation provides useful information for the large-scale implementation of standardized WPV-monitoring programs. ",
doi="10.2196/47377",
url="https://publichealth.jmir.org/2023/1/e47377",
url="http://www.ncbi.nlm.nih.gov/pubmed/37955961"
}


@Article{info:doi/10.2196/48864,
author="Bravata, M. Dena
and Kim, Joseph
and Russell, W. Daniel
and Goldman, Ron
and Pace, Elizabeth",
title="Digitally Enabled Peer Support Intervention to Address Loneliness and Mental Health: Prospective Cohort Analysis",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="6",
volume="7",
pages="e48864",
keywords="peer-support",
keywords="social isolation",
keywords="loneliness",
keywords="companionship",
keywords="depression",
keywords="anxiety",
keywords="quality of life",
keywords="occupational health",
abstract="Background: Social isolation and loneliness affect 61\% of US adults and are associated with significant increases in excessive mental and physical morbidity and mortality. Annual health care spending is US \$1643 higher for socially isolated individuals than for those not socially isolated. Objective: We prospectively evaluated the effects of participation with a digitally enabled peer support intervention on loneliness, depression, anxiety, and health-related quality of life among adults with loneliness. Methods: Adults aged 18 years and older living in Colorado were recruited to participate in a peer support program via social media campaigns. The intervention included peer support, group coaching, the ability to become a peer helper, and referral to other behavioral health resources. Participants were asked to complete surveys at baseline, 30, 60, and 90 days, which included questions from the validated University of California, Los Angeles Loneliness Scale, Patient Health Questionnaire 2-Item Scale, General Anxiety Disorder 7-Item Scale, and a 2-item measure assessing unhealthy days due to physical condition and mental condition. A growth curve modeling procedure using multilevel regression analyses was conducted to test for linear changes in the outcome variables from baseline to the end of the intervention. Results: In total, 815 ethnically and socially diverse participants completed registration (mean age 38, SD 12.7; range 18-70 years; female: n=310, 38\%; White: n=438, 53.7\%; Hispanic: n=133, 16.3\%; Black: n=51, 6.3\%; n=263, 56.1\% had a high social vulnerability score). Participants most commonly joined the following peer communities: loneliness (n=220, 27\%), building self-esteem (n=187, 23\%), coping with depression (n=179, 22\%), and anxiety (n=114, 14\%). Program engagement was high, with 90\% (n=733) engaged with the platform at 60 days and 86\% (n=701) at 90 days. There was a statistically (P<.001 for all outcomes) and clinically significant improvement in all clinical outcomes of interest: a 14.6\% (mean 6.47) decrease in loneliness at 90 days; a 50.1\% (mean 1.89) decline in depression symptoms at 90 days; a 29\% (mean 1.42) reduction in anxiety symptoms at 90 days; and a 13\% (mean 21.35) improvement in health-related quality of life at 90 days. Based on changes in health-related quality of life, we estimated a reduction in annual medical costs of US \$615 per participant. The program was successful in referring participants to behavioral health educational resources, with 27\% (n=217) of participants accessing a resource about how to best support those experiencing psychological distress and 15\% (n=45) of women accessing a program about the risks of excessive alcohol use. Conclusions: Our results suggest that a digitally enabled peer support program can be effective in addressing loneliness, depression, anxiety, and health-related quality of life among a diverse population of adults with loneliness. Moreover, it holds promise as a tool for identifying and referring members to relevant behavioral health resources. ",
doi="10.2196/48864",
url="https://formative.jmir.org/2023/1/e48864",
url="http://www.ncbi.nlm.nih.gov/pubmed/37930770"
}


@Article{info:doi/10.2196/45830,
author="Muroi, Kei
and Ishitsuka, Mami
and Hachisuka, Tomoko
and Shibata, Itsuka
and Ikeda, Tomohiko
and Hori, Daisuke
and Doki, Shotaro
and Takahashi, Tsukasa
and Sasahara, Shin-ichiro
and Matsuzaki, Ichiyo",
title="Factors Associated With Work Engagement of Nurses During the Fifth Wave of the COVID-19 Pandemic in Japan: Web-Based Cross-Sectional Study",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="3",
volume="7",
pages="e45830",
keywords="age",
keywords="COVID-19",
keywords="cross-sectional study",
keywords="engagement",
keywords="experience",
keywords="gender",
keywords="intensive care",
keywords="Japan",
keywords="JD-R model",
keywords="job demands-resources",
keywords="mental health",
keywords="nurses",
keywords="psychiatric",
keywords="psychological",
keywords="survey",
keywords="work engagement",
abstract="Background: The COVID-19 pandemic has brought to light the prevalence of mental health issues among nurses. Work engagement (WE) is a concept that describes work-related positive psychological states and is of importance within mental health measures. There is, however, a lack of research on factors associated with the WE of nurses during the COVID-19 pandemic. Objective: We aimed to determine which factors are associated with WE among nurses during the COVID-19 pandemic using the job demands-resources (JD-R) model as a framework. Methods: A web-based cross-sectional survey was conducted among nurses working in acute care and psychiatric institutions in the prefectures of Chiba and Tokyo in Japan. The survey period occurred between August 8 and September 30, 2021, during a time when the number of patients with a positive COVID-19 infection increased. The 3-item version of the Utrecht Work Engagement Scale (UWES-3) was used to measure WE. Factors such as age, gender, years of experience, affiliated ward, COVID-19--related stress, financial rewards from the government and hospital, encouragement from the government and patients, and workplace social capital were assessed. A total of 187 participants were included in the final analysis. Multiple regression analysis was performed to examine the factors related to WE. Partial regression coefficients (B), 95\% CI, and P values were calculated. Results: The mean overall score for the UWES-3 was 3.19 (SD 1.21). Factors negatively associated with UWES-3 were COVID-19--related stress on work motivation and escape behavior ($\Beta$ --0.16, 95\% CI --0.24 to --0.090; P<.001), and factors positively associated with UWES-3 were affiliation of intensive care units ($\Beta$ 0.76, 95\% CI 0.020-1.50; P=.045) and financial rewards from the government and hospital ($\Beta$ 0.40, 95\% CI 0.040-0.76; P=.03). Conclusions: This study examined factors related to WE among nurses during the COVID-19 pandemic using the JD-R model. When compared with findings from previous studies, our results suggest that nurses' WE was lower than before the COVID-19 pandemic. Negative motivation and escape behaviors related to COVID-19 were negatively associated with WE, while there were positive associations with financial rewards from the government and hospital and affiliation with an intensive care unit. Further research into larger populations is needed to confirm these findings. ",
doi="10.2196/45830",
url="https://formative.jmir.org/2023/1/e45830",
url="http://www.ncbi.nlm.nih.gov/pubmed/37921864"
}


@Article{info:doi/10.2196/48855,
author="Crocker, Kaitlyn
and Gnatt, Inge
and Haywood, Darren
and Bhat, Ravi
and Butterfield, Ingrid
and Raveendran Nair Lalitha, Anoop
and Bishop, Ruby
and Castle, J. David
and Jenkins, M. Zoe",
title="Investigating Attraction and Retention of Staff Within Public Mental Health Services in Victoria, Australia: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="31",
volume="12",
pages="e48855",
keywords="mental health personnel",
keywords="career choice",
keywords="recruitment",
keywords="retention, turnover intention",
keywords="public mental health",
keywords="mental health",
keywords="workforce",
keywords="challenges",
keywords="attraction",
keywords="retention of staff",
keywords="staff retention",
keywords="human resources",
keywords="human resourcing",
keywords="HR",
keywords="hire",
keywords="hiring",
keywords="new hire",
keywords="onboarding",
keywords="orientation",
abstract="Background: A large proportion of Australians are affected by mental illness each year, and treatment gaps are well known. To meet current and future demands and enable access to treatment that is safe, effective, and acceptable, a robust and sustainable mental health workforce is required. Factors reported to attract people to work within the mental health sector include aspiring to help others, having an interest in mental health and human behavior, the desire to make a difference and do something worthwhile, personal lived experience, recognition, and value of discipline-specific roles. However, despite the various reasons people enter the public mental health workforce, recruitment and retention continue to be ongoing challenges. To date, there has been limited investigation into understanding which factors are most relevant to the current Victorian workforce. Furthermore, a comparison to health care workers outside of mental health is also needed to better understand the specific needs of staff within the mental health sector. Objective: This study aims to explore factors related to attraction, recruitment, and retention of the public mental health workforce in Victoria, Australia. Methods: The study is a multisite, mixed methods cross-sectional study to be conducted at 4 public hospital services within Victoria, Australia: 2 in metropolitan and 2 in regional or rural locations. Current, previous, and nonmental health workers will be asked to complete a 20-25--minute web-based survey, which is developed based on previous research and offered participation in an optional 30-60--minute semistructured interview to examine personal experiences and perceptions. Both aspects of the project will examine factors related to attraction, recruitment, and retention in the public mental health workforce. Differences between groups (ie, current, past, and nonmental health workers), as well as location, discipline, and health setting will be examined. Regression analyses will be performed to determine the factors most strongly associated with retention (ie, job satisfaction) and turnover intention. Qualitative data will be transcribed verbatim and thematically analyzed to identify common themes. Results: As of May 2023, we enrolled 539 participants in the web-based survey and 27 participants in the qualitative interview. Conclusions: This project seeks to build on current knowledge from within Australia and internationally to understand role and service/system-related issues of attraction, recruitment, and retention specifically within Victoria, Australia. Seeking up-to-date information from across the health workforce may provide factors specific to mental health by illuminating any differences between mental health workers and health care workers outside of mental health. Furthermore, exploring motivators across health care disciplines and locations to enter, stay in, or leave a role in public mental health settings will provide valuable information to support how the sector plans and develops strategies that are fit for purpose. International Registered Report Identifier (IRRID): DERR1-10.2196/48855 ",
doi="10.2196/48855",
url="https://www.researchprotocols.org/2023/1/e48855",
url="http://www.ncbi.nlm.nih.gov/pubmed/37906222"
}


@Article{info:doi/10.2196/51474,
author="Blake, Holly
and Chaplin, J. Wendy
and Wainwright, Elaine
and Taylor, Gordon
and McNamee, Paul
and McWilliams, Daniel
and Abbott-Fleming, Victoria
and Holmes, Jain
and Fecowycz, Aaron
and Walsh, Andrew David
and Walker-Bone, Karen",
title="The Web-Based Pain-at-Work Toolkit With Telephone Support for Employees With Chronic or Persistent Pain: Protocol for a Cluster Randomized Feasibility Trial",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="30",
volume="12",
pages="e51474",
keywords="eHealth",
keywords="chronic pain",
keywords="disability",
keywords="workplace",
keywords="randomized controlled trial",
keywords="feasibility",
abstract="Background: Chronic or persistent pain affects one's ability to work or be productive at work, generating high societal and economic burden. However, the provision of work-related advice and support for people with chronic pain is variable or lacking. The Pain-at-Work (PAW) Toolkit was cocreated with people who live with pain, health care professionals, and employers. It aims to increase knowledge about employee rights and how to access support for managing a painful chronic condition in the workplace and provides advice on lifestyle behaviors that facilitate the management of chronic pain. Objective: We aimed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing access to the PAW Toolkit and telephone support calls from an occupational therapist (PAW) with treatment as usual (ie, standard support from their employer). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, and safety of this digital workplace health intervention. We will assess the candidate primary and secondary outcomes' feasibility and test research processes for a definitive trial. Methods: This is an open-label, parallel 2-arm pragmatic feasibility cluster randomized controlled trial with exploratory health economics analysis and a nested qualitative interview study. We aim to recruit 120 participants from at least 8 workplace clusters (any type, >10 employees) in England. The recruitment of workplaces occurs via personal approach, and the recruitment of individual participants is web based. Eligible participants are vocationally active adults aged ?18 years with internet access and self-reporting chronic pain interfering with their ability to undertake or enjoy productive work. A restricted 1:1 cluster-level randomization is used to allocate employment settings to PAW or treatment as usual; participants are unblinded to group allocation. Following site- and individual-level consent, participants complete a web-based baseline survey (time 0), including measures of work capacity, health and well-being, and health care resource use. Follow-up is performed at 3 months (time 1) and 6 months (time 2). Feasibility outcomes relate to recruitment; intervention fidelity (eg, delivery, reach, uptake, and engagement); retention; and follow-up. Qualitative evaluation (time 2) is mapped to the Capability, Opportunity, Motivation--Behavior model and will explore intervention acceptability to employees and employers, along with individual and contextual factors influencing the delivery and uptake of the intervention. Results: Ethics approval was obtained in March 2023. Trial recruitment began in June 2023. Conclusions: The PAW Toolkit is the first evidence-based digital health intervention aimed at supporting the self-management of chronic or persistent pain at work. This study will inform the design of a definitive trial, including sample size estimation, approaches to cluster site identification, primary and secondary outcomes' selection, and the final health economic model. Findings will inform approaches for the future delivery of this digital health intervention. Trial Registration: ClinicalTrials.gov NCT05838677; https://clinicaltrials.gov/study/NCT05838677 International Registered Report Identifier (IRRID): DERR1-10.2196/51474 ",
doi="10.2196/51474",
url="https://www.researchprotocols.org/2023/1/e51474",
url="http://www.ncbi.nlm.nih.gov/pubmed/37902814"
}


@Article{info:doi/10.2196/47050,
author="Kuehl, Kerry
and Elliot, Diane
and DeFrancesco, Carol
and McGinnis, Wendy
and Ek, Susanna
and Garg, Bharti",
title="A Web-Based Total Worker Health Intervention for Those Fighting Wildland Fires: Mixed Methods Development and Effectiveness Trial",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="25",
volume="25",
pages="e47050",
keywords="wildland",
keywords="firefighter",
keywords="Total Worker Health",
keywords="web-based",
keywords="occupational safety",
keywords="health promotion",
keywords="wildland firefighter",
keywords="web-based safety",
keywords="mixed methods",
keywords="occupational health",
keywords="health and safety",
keywords="health care worker",
keywords="mobile phone",
abstract="Background: Fire seasons are longer, with more and larger wildfires, placing increased demands and risks on those fighting wildland fires. There are multiple agencies involved with fighting wildland fires and unique worksite conditions make meeting these workers' needs a challenge. Objective: The aim of the study is to develop and establish the effectiveness of a web-based safety and health program for those fighting wildland fires. Methods: This mixed methods project had 3 phases. The initial qualitative phase assessed the needs of 150 diverse firefighters through interviews and focus groups across 11 US sites to establish and prioritize program content. Interview transcripts were read for thematic content with iterative readings used to identify, code, and rank health and safety issues. The second phase used that information to build a comprehensive Total Worker Health program for those fighting wildfires. The program content was based on the qualitative interview data and consisted of 6 core and 8 elective 30-minute, web-based modules primarily done individually on a smartphone or computer. The final, third phase evaluated the program with a quantitative prospective proof-of-concept, usability, and effectiveness trial among wildland firefighter participants. Effectiveness was assessed with paired 2-tailed t tests for pre- and post-Likert agreement scale survey items, adjusted for multiple comparisons. In addition to assessing mean and SD at baseline and postsurvey, observed effect sizes were calculated (Cohen d). Usability and reaction to the program among firefighters who responded to postsurvey were also assessed. Results: The qualitative themes and subthemes were used to inform the program's content. For the effectiveness trial, 131 firefighters completed the presurvey, and 50 (38.2\%) completed the postsurvey. The majority of the participants were White (n=123, 93.9\%), male (n=117, 89.3\%), with an average age of 41 (SD 12.9) years. Significant increases in knowledge and desired health and safety behaviors were found for both cancer (P<.001) and cardiovascular risk (P=.01), nutrition behaviors (P=.01), hydration or overheating (P=.001), binge drinking (P=.002), and getting medical checkups (P=.001). More than 80\% (n=40) of postsurvey respondents agreed or strongly agreed that the program was easy to use and would recommend it to others. Conclusions: An innovative web-based safety and health promotion program for those fighting wildland fires was feasible, scalable, and usable. It improved the health and safety of those fighting wildland fires. Trial Registration: ClinicalTrials.gov NCT05753358; https://classic.clinicaltrials.gov/ct2/show/NCT05753358 ",
doi="10.2196/47050",
url="https://www.jmir.org/2023/1/e47050",
url="http://www.ncbi.nlm.nih.gov/pubmed/37878362"
}


@Article{info:doi/10.2196/48758,
author="Thomson, Louise
and Hassard, Juliet
and Frost, Alexandra
and Bartle, Craig
and Yarker, Joanna
and Munir, Fehmidah
and Kneller, Richard
and Marwaha, Steven
and Daly, Guy
and Russell, Sean
and Meyer, Caroline
and Vaughan, Benjamin
and Newman, Kristina
and Blake, Holly",
title="Digital Training Program for Line Managers (Managing Minds at Work): Protocol for a Feasibility Pilot Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="24",
volume="12",
pages="e48758",
keywords="acceptability",
keywords="anxiety",
keywords="burnout",
keywords="cluster randomised control trial",
keywords="depression",
keywords="digital training",
keywords="feasibility",
keywords="intervention",
keywords="managers",
keywords="mental health",
keywords="stress",
keywords="usability",
keywords="work",
keywords="workplace",
abstract="Background: Mental health problems affect 1 in 6 workers annually and are one of the leading causes of sickness absence, with stress, anxiety, and depression being responsible for half of all working days lost in the United Kingdom. Primary interventions with a preventative focus are widely acknowledged as the priority for workplace mental health interventions. Line managers hold a primary role in preventing poor mental health within the workplace and, therefore, need to be equipped with the skills and knowledge to effectively carry out this role. However, most previous intervention studies have directly focused on increasing line managers' understanding and awareness of mental health rather than giving them the skills and competencies to take a proactive preventative approach in how they manage and design work. The Managing Minds at Work (MMW) digital training intervention was collaboratively designed to address this gap. The intervention aims to increase line managers' knowledge and confidence in preventing work-related stress and promoting mental health at work. It consists of 5 modules providing evidence-based interactive content on looking after your mental health, designing and managing work to promote mental well-being, management competencies that prevent work-related stress, developing a psychologically safe workplace, and having conversations about mental health at work. Objective: The primary aim of this study is to pilot and feasibility test MMW, a digital training intervention for line managers. Methods: We use a cluster randomized controlled trial design consisting of 2 arms, the intervention arm and a 3-month waitlist control, in this multicenter feasibility pilot study. Line managers in the intervention arm will complete a baseline questionnaire at screening, immediately post intervention (approximately 6 weeks after baseline), and at 3- and 6-month follow-ups. Line managers in the control arm will complete an initial baseline questionnaire, repeated after 3 months on the waitlist. They will then be granted access to the MMW intervention, following which they will complete the questionnaire post intervention. The direct reports of the line managers in both arms of the trial will also be invited to take part by completing questionnaires at baseline and follow-up. As a feasibility pilot study, a formal sample size is not required. A minimum of 8 clusters (randomized into 2 groups of 4) will be sought to inform a future trial from work organizations of different types and sectors. Results: Recruitment for the study closed in January 2022. Overall, 24 organizations and 224 line managers have been recruited. Data analysis was finished in August 2023. Conclusions: The results from this feasibility study will provide insight into the usability and acceptability of the MMW intervention and its potential for improving line manager outcomes and those of their direct reports. These results will inform the development of subsequent trials. Trial Registration: ClinicalTrials.gov NCT05154019; https://clinicaltrials.gov/study/NCT05154019 International Registered Report Identifier (IRRID): DERR1-10.2196/48758 ",
doi="10.2196/48758",
url="https://www.researchprotocols.org/2023/1/e48758",
url="http://www.ncbi.nlm.nih.gov/pubmed/37874612"
}


@Article{info:doi/10.2196/45678,
author="Toh, Yang Sean Han
and Lee, Chi Sze
and S{\"u}ndermann, Oliver",
title="Mobile Behavioral Health Coaching as a Preventive Intervention for Occupational Public Health: Retrospective Longitudinal Study",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="20",
volume="7",
pages="e45678",
keywords="mobile health apps",
keywords="mHealth apps",
keywords="behavioral health coaching",
keywords="behavioral coaching",
keywords="app-based coaching",
keywords="self-help",
keywords="employees",
keywords="well-being",
keywords="mood",
keywords="stress",
keywords="public health",
keywords="preventive interventions",
keywords="positive psychology",
abstract="Background: Researchers have recently proposed that behavioral health coaching (BHC) is effective in promoting proactive care among employees. However, to qualify as a preventive workplace intervention, more research is needed to evaluate whether BHC can further elevate well-being among moderately mentally healthy employees. Objective: Using real-world data, this study evaluates the preliminary effectiveness of app-based BHC against a nonrandomized control group with open access to self-help tools in improving well-being (ie, mood levels and perceived stress). The study also explores the active ingredients of BHC and dose-response associations between the number of BHC sessions and well-being improvements. Methods: Employees residing across Asia-Pacific countries (N=1025; mean age 30.85, SD 6.97 y) who reported moderately positive mood and medium levels of perceived stress in their first week of using the mental health app Intellect were included in this study. Users who were given access by their organizations to Intellect's BHC services were assigned to the ``Coaching'' condition (512/1025, 49.95\%; mean age 31.09, SD 6.87 y), whereas other employees remained as ``Control'' participants (513/1025, 50.05\%; mean age 30.61, SD 7.06 y). To evaluate effectiveness, monthly scores from the validated mood and stress sliders were aggregated into a composite well-being score and further examined using repeated-measure conditional growth models. Postcoaching items on ``Perceived Usefulness of the BHC session'' and ``Working Alliance with my Coach'' were examined as active ingredients of BHC using 1-1-1 multilevel mediation models. Finally, 2-way repeated-measure mixed ANOVA models were conducted to examine dose-response effects on well-being improvements between groups (coaching and control) across time. Results: Growth curve analyses revealed significant time by group interaction effects for composite well-being, where ``Coaching'' users reported significantly greater improvements in well-being than ``Control'' participants across time (composite well-being: F1,391=6.12; $\eta$p2=0.02; P=.01). Among ``Coaching'' participants, dependent-sample 2-tailed t tests revealed significant improvements in composite well-being from baseline to 11 months (t512=1.98; Cohen d=0.17; P=.049). Improvements in ``Usefulness of the BHC session'' ($\beta$=.078, 95\% Cl .043-.118; P<.001) and ``Working Alliance'' ($\beta$=.070, 95\% Cl .037-.107; P<.001) fully mediated within-level well-being enhancements over time. Comparing against baseline or first month scores, significant time by group interactions were observed between the second and sixth months, with the largest effect size observed at the fifth month mark (first month vs fifth month: F1,282=15.0; P<.001; $\eta$p2=0.051). Conclusions: We found preliminary evidence that BHC is an effective preventive workplace intervention. Mobile-based coaching may be a convenient, cost-effective, and scalable means for organizations and governments to boost public mental health. ",
doi="10.2196/45678",
url="https://formative.jmir.org/2023/1/e45678",
url="http://www.ncbi.nlm.nih.gov/pubmed/37862086"
}


@Article{info:doi/10.2196/50306,
author="Cavalcante de Oliveira, Paula Ana
and Lopes Galante, Mariana
and Senna Maia, Leila
and Craveiro, Isabel
and Pereira da Silva, Alessandra
and Fronteira, Ines
and Chan{\c{c}}a, Raphael
and Ferrinho, Paulo
and Dal Poz, Mario",
title="Policies and Management Interventions to Enhance Health and Care Workforce Capacity for Addressing the COVID-19 Pandemic: Protocol for a Living Systematic Review",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="5",
volume="12",
pages="e50306",
keywords="COVID-19",
keywords="health and care workforce policy",
keywords="health and care workforce capacity",
keywords="management interventions",
keywords="SARS-CoV-2",
keywords="pandemic",
abstract="Background: Countries and health systems have had to make challenging resource allocation and capacity-building decisions to promote proper patient care and ensure health and care workers' safety and well-being, so that they can effectively address the present COVID-19 pandemic as well as upcoming public health problems and natural catastrophes. As innovations are already in place and updated evidence is published daily, more information is required to inform the development and implementation of policies and interventions to improve health and care workforce capacity to address the COVID-19 pandemic response. Objective: The objective of this protocol review is to identify countries' range of experiences with policies and management interventions that can improve health and care workers' capacity to address the COVID-19 pandemic response and synthesize evidence on the effectiveness of the interventions. Methods: We will conduct a living systematic review of quantitative, qualitative, and mixed methods studies and gray literature (technical and political documents) published in English, French, Hindi, Portuguese, Italian, and Spanish between January 1, 2000, and March 1, 2022. The databases to be searched are MEDLINE (PubMed), Embase, SCOPUS, and Latin American and Caribbean Health Sciences Literature. In addition, the World Health Organization's COVID-19 Research Database and the websites of international organizations (International Labour Organization, Economic Co-operation and Development, and The Health System Response Monitor) will be searched for unpublished studies and gray literature. Data will be extracted from the selected documents using an electronic form adapted from the Joanna Briggs Institute quantitative and qualitative tools for data extraction. A convergent integrated approach to synthesis and integration will be used. The risk of bias will be assessed with Joanna Briggs Institute critical appraisal tools, and the certainty of the evidence in the presented outcomes will be assessed with the Grading of Recommendations, Assessment, Development and Evaluation. Results: The database and gray literature search retrieved 3378 documents. Data are being analyzed by 2 independent reviewers. The study is expected to be published by the end of 2023 in a peer-reviewed journal. Conclusions: This review will allow us to identify and describe the policies and strategies implemented by countries and their effectiveness, as well as identify gaps in the evidence. Trial Registration: PROSPERO CRD42022327041; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=327041 International Registered Report Identifier (IRRID): RR1-10.2196/50306 ",
doi="10.2196/50306",
url="https://www.researchprotocols.org/2023/1/e50306",
url="http://www.ncbi.nlm.nih.gov/pubmed/37796568"
}


@Article{info:doi/10.2196/42851,
author="Min, Beomjun
and Park, Heyeon
and Kim, Inhyang Johanna
and Lee, Sungmin
and Back, Soyoung
and Lee, Eunhwa
and Oh, Sohee
and Yun, Je-Yeon
and Kim, Bung-Nyun
and Kim, Yonghoon
and Hwang, JungHyun
and Lee, Sanghyop
and Kim, Jeong-Hyun",
title="The Effectiveness of a Neurofeedback-Assisted Mindfulness Training Program Using a Mobile App on Stress Reduction in Employees: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Oct",
day="3",
volume="11",
pages="e42851",
keywords="mindfulness",
keywords="neurofeedback",
keywords="stress",
keywords="resilience",
keywords="mobile app",
keywords="employee",
abstract="Background: Mindfulness-based training programs have consistently shown efficacy in stress reduction. However, questions regarding the optimal duration and most effective delivery methods remain. Objective: This research explores a 4-week neurofeedback-assisted mindfulness training for employees via a mobile app. The study's core query is whether incorporating neurofeedback can amplify the benefits on stress reduction and related metrics compared with conventional mindfulness training. Methods: A total of 92 full-time employees were randomized into 3 groups: group 1 received mobile mindfulness training with neurofeedback assistance (n=29, mean age 39.72 years); group 2 received mobile mindfulness training without neurofeedback (n=32, mean age 37.66 years); and group 3 were given self-learning paper materials on stress management during their first visit (n=31, mean age 38.65 years). The primary outcomes were perceived stress and resilience scales. The secondary outcomes were mindfulness awareness, emotional labor, occupational stress, insomnia, and depression. Heart rate variability and electroencephalography were measured for physiological outcomes. These measurements were collected at 3 different times, namely, at baseline, immediately after training, and at a 4-week follow-up. The generalized estimating equation model was used for data analysis. Results: The 4-week program showed significant stress reduction (Wald $\chi$22=107.167, P<.001) and improvements in psychological indices including resilience, emotional labor, insomnia, and depression. A significant interaction was observed in resilience (time {\texttimes} group, Wald $\chi$42=10.846, P=.02). The post hoc analysis showed a statistically significant difference between groups 1 (least squares mean [LSM] 21.62, SE 0.55) and 3 (LSM 19.90, SE 0.61) at the posttraining assessment (P=.008). Group 1 showed a significant improvement (P<.001) at the posttraining assessment, with continued improvements through the 1-month follow-up assessment period (LSM 21.55, SE 0.61). Physiological indices were analyzed only for data of 67 participants (22 in group 1, 22 in group 2, and 23 in group 3) due to the data quality. The relaxation index (ratio of alpha to high beta power) from the right electroencephalography channel showed a significant interaction (time {\texttimes} group, Wald $\chi$22=6.947, P=.03), with group 1 revealing the highest improvement (LSM 0.43, SE 0.15) compared with groups 2 (LSM --0.11, SE 0.10) and 3 (LSM 0.12, SE 0.10) at the 1-month follow-up assessment. Conclusions: The study demonstrated that the neurofeedback-assisted group achieved superior outcomes in resilience and relaxation during the 4-week mobile mindfulness program. Further research with larger samples and long-term follow-up is warranted. Trial Registration: ClinicalTrials.gov NCT03787407; https://clinicaltrials.gov/ct2/show/NCT03787407 ",
doi="10.2196/42851",
url="https://mhealth.jmir.org/2023/1/e42851",
url="http://www.ncbi.nlm.nih.gov/pubmed/37788060"
}


@Article{info:doi/10.2196/46878,
author="Svanholm, Frida
and Turesson, Christina
and L{\"o}fgren, Monika
and Bj{\"o}rk, Mathilda",
title="Acceptability of the eHealth Intervention Sustainable Worker Digital Support for Persons With Chronic Pain and Their Employers (SWEPPE): Questionnaire and Interview Study",
journal="JMIR Hum Factors",
year="2023",
month="Sep",
day="28",
volume="10",
pages="e46878",
keywords="chronic pain",
keywords="digital support",
keywords="eHealth",
keywords="return to work",
keywords="rehabilitation",
keywords="support",
keywords="quality of life",
keywords="implementation",
keywords="acceptability",
keywords="interview",
keywords="questionnaire",
keywords="qualitative",
keywords="barrier",
keywords="users",
keywords="mobile phone",
abstract="Background: Sick leave and decreased ability to work are the consequences of chronic pain. Interdisciplinary pain rehabilitation programs (IPRPs) aim to improve health-related quality of life and participation in work activities, although implementing rehabilitation strategies at work after IPRPs can be difficult. Employers' knowledge about pain and the role of rehabilitation needs to be strengthened. The self-management of chronic pain can be improved through eHealth interventions. However, these interventions do not involve communicating with employers to improve work participation. To address this deficiency, a new eHealth intervention, Sustainable Worker Digital Support for Persons with Chronic Pain and Their Employers (SWEPPE), was developed. Objective: This study aimed to describe the acceptability of SWEPPE after IPRPs from the perspective of patients with chronic pain and their employers. Methods: This study included 11 patients and 4 employers who were recruited to test SWEPPE in daily life for 3 months after IPRPs. Data were collected using individual interviews at the end of the 3-month test period and questionnaires, which were completed when SWEPPE was introduced (questionnaire 1) and at a 3-month follow-up (questionnaire 2). Data were also collected on how often SWEPPE was used. Qualitative data were analyzed through a qualitative content analysis using an abductive approach. The framework used for the deductive approach was the theoretical framework of acceptability. Quantitative data were analyzed through descriptive statistics and the differences between the responses to questionnaires 1 and questionnaire 2 using the Wilcoxon signed rank test. Results: Both patients and employers reported that SWEPPE increased their knowledge and understanding of how to improve work participation and helped them identify goals, barriers, and strategies for return to work. In addition, participants noted that SWEPPE improved employer-employee communication and collaboration. However, experiences and ratings varied among participants and the different SWEPPE modules. The acceptability of SWEPPE was lower in patients who experienced significant pain and fatigue. A high degree of flexibility and choice of ratings in SWEPPE were generally described as helpful. Conclusions: This study shows promising results on the user acceptability of SWEPPE from both patient and employer perspectives. However, the variations among patients and modules indicate a need for further testing and research to refine the content and identify the group of patients who will best benefit from SWEPPE. ",
doi="10.2196/46878",
url="https://humanfactors.jmir.org/2023/1/e46878",
url="http://www.ncbi.nlm.nih.gov/pubmed/37768708"
}


@Article{info:doi/10.2196/45535,
author="Elliot, Diane
and Kuehl, Kerry
and DeFrancesco, Carol
and McGinnis, Wendy
and Ek, Susanna
and Van Horne, Allee
and Kempany, Ginsberg Katherine",
title="Technology-Enabled Intervention to Enhance Mindfulness, Safety, and Health Promotion Among Corrections Professionals: Protocol for a Prospective Quasi-Experimental Trial",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="22",
volume="12",
pages="e45535",
keywords="corrections professionals",
keywords="mindfulness",
keywords="total worker health",
keywords="occupational safety",
keywords="digital",
keywords="health promotion",
keywords="safety",
keywords="depression",
keywords="suicide",
keywords="obesity",
keywords="cardiovascular disease",
keywords="well-being",
keywords="stress",
keywords="survey",
keywords="healthy eating",
keywords="physical activity",
keywords="mood",
keywords="vascular health",
keywords="injury",
keywords="cop",
keywords="police",
keywords="security",
keywords="undercover",
keywords="remand",
keywords="detention",
keywords="prison",
keywords="state correctional",
keywords="state corrections",
keywords="correction",
keywords="penitentiary",
abstract="Background: Correction professionals are a highly stressed workforce with heightened risks for depression, suicide, obesity, cardiovascular disease, and injury. These professionals, largely hidden from view, have received little study concerning means to improve their safety, health, and well-being. In other settings, mindfulness has resulted in lowered stress, along with other benefits. We hypothesized that a program that promoted mindfulness combined with more typical health and safety components could uniquely benefit corrections professionals. Objective: This project will assess a novel scalable, self-administered program to enhance the mindfulness, safety, and health of a vulnerable worker group. Methods: In partnership with the Oregon Department of Corrections, we are conducting a prospective quasi-experimental trial of a safety, health, and mindfulness program among 100 corrections professionals from 2 institutions. Survey and physiologic data will be collected at enrollment, upon weekly program completion (3 months), and at 9 months after enrollment. Primary outcome behaviors promoted by the program are being mindful, healthier eating, more physical activity, and greater restorative sleep. Secondary downstream benefits are anticipated in stress level, mood, positive feelings about the organization, vascular health, and cellular aging, along with job performance, injuries, and economic costs. Participants will meet in-person or in a Zoom-type meeting as 3- to 5-member coworker groups during their usual work hours for 30-minute sessions once a week for 12 weeks. The program uses self-guided web-based learning modules that include brief mindfulness practice, and it is accessible by smartphone, tablet, or laptop. Daily mindfulness practice is encouraged between sessions, which is facilitated by the study website and group format. The modules' structure emphasizes prerequisite knowledge, peer support, skill practice, self-monitoring, and enhancing self-efficacy for change. The program continues through self-directed use of the Headspace app following the 12 weekly sessions. Results: Participants are being enrolled, and the intervention is ready to launch. Conclusions: Although mindfulness training has gained traction for worker well-being, its usual format requires a skilled trainer, an initial retreat, and weekly 2-hour meetings for several weeks. The content is limited to mindfulness without safety or health promotion aspects. The need for skilled trainers and time commitment limits the scalability of the usual mindfulness interventions. The planned program is an innovative combination of technology, e-learning, and a group format to add mindfulness to a safety and health curriculum. If acceptable and effective, the format would facilitate its widespread use. Trial Registration: ClinicalTrials.gov NCT05608889; https://classic.clinicaltrials.gov/ct2/show/NCT05608889 International Registered Report Identifier (IRRID): PRR1-10.2196/45535 ",
doi="10.2196/45535",
url="https://www.researchprotocols.org/2023/1/e45535",
url="http://www.ncbi.nlm.nih.gov/pubmed/36602914"
}


@Article{info:doi/10.2196/48730,
author="Heeres, J. Tjitske
and Tran, Mikael Tri
and Noort, A.C. Bart",
title="Drivers and Barriers to Implementing the Internet of Things in the Health Care Supply Chain: Mixed Methods Multicase Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="20",
volume="25",
pages="e48730",
keywords="digital health",
keywords="drivers and barriers",
keywords="healthcare logistics",
keywords="healthcare supply chain",
keywords="implementation",
keywords="Internet of Things",
keywords="supply chain management",
abstract="Background: Over the past 2 years, the COVID-19 pandemic has placed enormous pressure on the health care industry. There has been an increase in demand and, at the same time, a shortage of supplies. This has shown that supply chain management in the health care industry cannot be taken for granted. Furthermore, the health care industry is also facing other major challenges, such as the current labor market shortage. In the literature, the Internet of Things (IoT) is highlighted as an effective tool to build a more resilient and efficient supply chain that can manage these challenges. Although using IoT in supply chain management has been extensively examined in other types of supply chains, its use in the health care supply chain has largely been overlooked. Given that the health care supply chain, compared to others, is more complex and is under growing pressure, a more in-depth understanding of the opportunities brought by IoT is necessary. Objective: This study aims to address this research gap by identifying and ranking the drivers of and barriers to implementing IoT in the health care supply chain. Methods: We conducted a 2-stage study. In the first, exploratory stage, a total of 12 semistructured interviews were conducted to identify drivers and barriers. In the second, confirmatory stage, a total of 26 health care supply chain professionals were asked in a survey to rank the drivers and barriers. Results: The results show that there are multiple financial, operational, strategy-related, and supply chain-related drivers for implementing IoT. Similarly, there are various financial, strategy-related, supply chain-related, technology-related, and user-related barriers. The findings also show that supply chain-related drivers (eg, increased transparency, traceability, and collaboration with suppliers) are the strongest drivers, while financial barriers (eg, high implementation costs and difficulties in building a business case) are the biggest barriers to overcome. Conclusions: The findings of this study add to the limited literature regarding IoT in the health care supply chain by empirically identifying the most important drivers and barriers to IoT implementation. The ranking of drivers and barriers provides guidance for practitioners and health care provider leaders intending to implement IoT in the health care supply chain. ",
doi="10.2196/48730",
url="https://www.jmir.org/2023/1/e48730",
url="http://www.ncbi.nlm.nih.gov/pubmed/37728990"
}


@Article{info:doi/10.2196/49020,
author="Strout, Kelley
and Schwartz-Mette, Rebecca
and McNamara, Jade
and Parsons, Kayla
and Walsh, Dyan
and Bonnet, Jen
and O'Brien, M. Liam
and Robinson, Kathryn
and Sibley, Sean
and Smith, Annie
and Sapp, Maile
and Sprague, Lydia
and Sabegh, Sajedi Nima
and Robinson, Kaitlin
and Henderson, Amanda",
title="Wellness in Nursing Education to Promote Resilience and Reduce Burnout: Protocol for a Holistic Multidimensional Wellness Intervention and Longitudinal Research Study Design in Nursing Education",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="8",
volume="12",
pages="e49020",
keywords="nursing workforce",
keywords="academic performance",
keywords="burnout",
keywords="resilience",
keywords="wellness",
keywords="nursing",
keywords="education",
keywords="nursing education",
keywords="protocol",
keywords="nursing students",
keywords="students",
keywords="holistic",
keywords="implementation",
keywords="workforce",
abstract="Background: The United States faces a nursing shortage driven by a burnout epidemic among nurses and nursing students. Nursing students are an integral population to fuel the nursing workforce at high risk of burnout and increased rates of perceived stress. Objective: The aim of this paper is to describe WellNurse, a holistic, interdisciplinary, multidimensional longitudinal research study that examines evidence-based interventions intended to reduce burnout and increase resilience among graduate and undergraduate nursing students. Methods: Graduate and undergraduate nursing students matriculated at a large public university in the northeastern United States are eligible to enroll in this ongoing, longitudinal cohort study beginning in March 2021. Participants complete a battery of health measurements twice each semester during the fourth week and the week before final examinations. The measures include the Perceived Stress Scale, the Satisfaction with Life Scale, the Oldenburg Burnout Inventory, the Brief Resilience Scale, and the Pittsburgh Sleep Quality Index. Participants are eligible to enroll in a variety of interventions, including mindfulness-based stress reduction, mindful eating, fitness training, and massage therapy. Those who enroll in specific, targeted interventions complete additional measures designed to target the aim of the intervention. All participants receive a free Fitbit device. Additional environmental changes are being implemented to further promote a culture that supports academic well-being, including recruiting a diverse student population through evidence-based holistic admissions, inclusive teaching design, targeted resilience and stress reduction workshops, and cultural shifts within classrooms and curricula. The study design protocol is registered at Open Science Framework DOI 10.17605/OSF.IO/NCBPE. Results: The project was funded on January 1, 2022. Data collection started in March 2022. A total of 267 participants have been recruited. Results will be published after each semester starting in December 2023. WellNurse evaluation follows the Rapid Cycle Quality Improvement framework to continuously monitor ongoing project processes, activity outcomes, and progress toward reducing burnout and increasing resilience. Rapid Cycle Quality Improvement promotes the ability to alter WellNurse interventions, examine multiple interventions, and test their effectiveness among the nursing education population to identify the most effective interventions. Conclusions: Academic nursing organizations must address student burnout risk and increase resilience to produce a future workforce that provides high-quality patient care to a diverse population. Findings from WellNurse will support evidence-based implementations for public baccalaureate and master's nursing programs in the United States. International Registered Report Identifier (IRRID): DERR1-10.2196/49020 ",
doi="10.2196/49020",
url="https://www.researchprotocols.org/2023/1/e49020/"
}


@Article{info:doi/10.2196/43692,
author="Boskma, Amber
and van der Braak, Kim
and Ansari, Neda
and Hooft, Lotty
and Wietasch, G{\"o}tz
and Franx, Arie
and van der Laan, Maarten",
title="Assessing the Well-Being at Work of Nurses and Doctors in Hospitals: Protocol for a Scoping Review of Monitoring Instruments",
journal="JMIR Res Protoc",
year="2023",
month="Aug",
day="25",
volume="12",
pages="e43692",
keywords="well-being at work",
keywords="well-being",
keywords="well being",
keywords="health care professionals",
keywords="doctors",
keywords="nurses",
keywords="monitoring",
keywords="assessment",
keywords="measure",
keywords="scale",
keywords="instruments",
keywords="scoping literature review",
keywords="occupational health",
abstract="Background: Well-being at work can be defined as ``creating an environment to promote a state of contentment which allows an employee to flourish and achieve their full potential for the benefit of themselves and their organisation.'' In the health care context, well-being at work of nurses and doctors is important for good patient care. Moreover, it is strongly associated with individual- and organization-level consequences. Relevant literature presents models and concepts of physical, mental, and social well-being. This study uses the 6 elements of the job demands-resources (JD-R) model to interpret well-being at work (job demands, job resources, personal resources, leadership, well-being, and outcomes) as part of a Netherlands Federation of University Medical Hospitals program to find ways to improve and monitor health care professionals' well-being in Dutch hospitals. Many instruments exist to measure well-being at work in terms of population, setting, and other aspects. An overview of available and eligible instruments assessing and monitoring the well-being of nurses and doctors is currently missing. Objective: We will perform a scoping review aiming to provide an overview of validated instruments assessing and monitoring the well-being of nurses and doctors at work. Methods: We will perform a search of published literature in the following databases: Medline, Embase, and CINAHL. Studies will be eligible if they (1) assess well-being at work of nurses and doctors employed in hospitals; (2) describe an evaluation of an instrument or review an instrument; (3) measure well-being at work or aspects of well-being at work according to the elements of the JD-R model, and (4) were published in English from 2011 onwards. Title/abstract screening according to the eligibility criteria will be followed by full-text screening. Data extraction of included studies will be conducted by 3 reviewers independently. Reviewers will use standardized data extraction forms that include study characteristics, sample characteristics, measurement instrument details, and psychometric properties. The analysis will be descriptive. When synthesizing the data, a distinction will be made between comprehensive instruments and common instruments. Results: This scoping review identifies instruments that have been developed and validated for monitoring the well-being of nurses and doctors at work. Studies were searched between September and December 2021 and screened between December 2021 and May 2022. A total of 739 studies were included. Conclusions: Timely screening of well-being at work may be beneficial for individual health care workers, the organization, and patients. There is often a substantial gap and mismatch between employer perceptions of well-being and well-being interventions. It is important to develop and implement suitable interventions adapted to the needs of nurses and doctors and their health or other problems. Well-being screening should be timely to gain insight into these needs and problems. Moreover, to determine the effectiveness of well-being interventions, measurement is mandatory. The results will be critical for organizations to select a monitoring instrument that best fits the needs of employees and organizations. International Registered Report Identifier (IRRID): DERR1-10.2196/43692 ",
doi="10.2196/43692",
url="https://www.researchprotocols.org/2023/1/e43692",
url="http://www.ncbi.nlm.nih.gov/pubmed/37624632"
}


@Article{info:doi/10.2196/45963,
author="Deady, Mark
and Collins, J. Daniel A.
and Lavender, Isobel
and Mackinnon, Andrew
and Glozier, Nicholas
and Bryant, Richard
and Christensen, Helen
and Harvey, B. Samuel",
title="Selective Prevention of Depression in Workers Using a Smartphone App: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="24",
volume="25",
pages="e45963",
keywords="depression",
keywords="smartphone app",
keywords="workplace mental health",
keywords="randomized controlled trial",
keywords="prevention",
keywords="stress",
keywords="mobile phone",
abstract="Background: There is increasing evidence that depression can be prevented; however, universal approaches have had limited success. Appropriate targeting of interventions to at-risk populations has been shown to have potential, but how to selectively determine at-risk individuals remains unclear. Workplace stress is a risk factor for depression and a target for intervention, but few interventions exist to prevent depression among workers at risk due to heightened stress. Objective: This trial aimed to evaluate the efficacy of a smartphone-based intervention in reducing the onset of depression and improving related outcomes in workers experiencing at least moderate levels of stress. Methods: A randomized controlled trial was conducted with participants who were currently employed and reported no clinically significant depression and at least moderate stress. The intervention group (n=1053) were assigned Anchored, a 30-day self-directed smartphone app-based cognitive behavioral- and mindfulness-based intervention. The attention-control group (n=1031) were assigned a psychoeducation website. Assessment was performed via web-based self-report questionnaires at baseline and at 1-, 3-, and 6-month postbaseline time points. The primary outcome was new depression caseness aggregated over the follow-up period. The secondary outcomes included depressive and anxiety symptoms, stress, well-being, resilience, work performance, work-related burnout, and quality of life. Analyses were conducted within an intention-to-treat framework using mixed modeling. Results: There was no significant between-group difference in new depression caseness (z score=0.69; P=.49); however, those in the Anchored arm had significantly greater depressive symptom reduction at 1 month (Cohen d=0.02; P=.049) and 6 months (Cohen d=0.08; P=.03). Anchored participants also showed significantly greater reduction in anxiety symptoms at 1 month (Cohen d=0.07; P=.04) and increased work performance at 1 month (Cohen d=0.07; P=.008) and 6 months (Cohen d=0.13; P=.01), compared with controls. Notably, for Anchored participants completing at least two-thirds of the intervention, there was a significantly lower rate of depression onset (1.1\%, 95\% CI 0.0\%-3.7\%) compared with controls (9.0\%, 95\% CI 6.8\%-12.3\%) at 1 month (z score=4.50; P<.001). Significant small to medium effect sizes for most secondary outcomes were seen in the highly engaged Anchored users compared with controls, with effects maintained at the 6-month follow-up for depressive symptoms, well-being, stress, and quality of life. Conclusions: Anchored was associated with a small comparative reduction in depressive symptoms compared with controls, although selective prevention of case-level depression was not observed in the intention-to-treat analysis. When users adequately engaged with the app, significant findings pertaining to depression prevention, overall symptom reduction, and functional improvement were found, compared with controls. There is a need for a greater focus on engagement techniques in future research. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000178943; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378592 ",
doi="10.2196/45963",
url="https://www.jmir.org/2023/1/e45963",
url="http://www.ncbi.nlm.nih.gov/pubmed/37616040"
}


@Article{info:doi/10.2196/45834,
author="Ito-Masui, Asami
and Sakamoto, Ryota
and Matsuo, Eri
and Kawamoto, Eiji
and Motomura, Eishi
and Tanii, Hisashi
and Yu, Han
and Sano, Akane
and Imai, Hiroshi
and Shimaoka, Motomu",
title="Effect of an Internet--Delivered Cognitive Behavioral Therapy--Based Sleep Improvement App for Shift Workers at High Risk of Sleep Disorder: Single-Arm, Nonrandomized Trial",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="22",
volume="25",
pages="e45834",
keywords="shift worker sleep disorder",
keywords="internet-based cognitive behavioral therapy",
keywords="mobile apps",
keywords="fitness tracker",
keywords="subjective well-being",
keywords="machine learning",
keywords="mobile phone",
abstract="Background: Shift workers are at high risk of developing sleep disorders such as shift worker sleep disorder or chronic insomnia. Cognitive behavioral therapy (CBT) is the first-line treatment for insomnia, and emerging evidence shows that internet-based CBT is highly effective with additional features such as continuous tracking and personalization. However, there are limited studies on internet-based CBT for shift workers with sleep disorders. Objective: This study aimed to evaluate the impact of a 4-week, physician-assisted, internet-delivered CBT program incorporating machine learning--based well-being prediction on the sleep duration of shift workers at high risk of sleep disorders. We evaluated these outcomes using an internet-delivered CBT app and fitness trackers in the intensive care unit. Methods: A convenience sample of 61 shift workers (mean age 32.9, SD 8.3 years) from the intensive care unit or emergency department participated in the study. Eligible participants were on a 3-shift schedule and had a Pittsburgh Sleep Quality Index score ?5. The study comprised a 1-week baseline period, followed by a 4-week intervention period. Before the study, the participants completed questionnaires regarding the subjective evaluation of sleep, burnout syndrome, and mental health. Participants were asked to wear a commercial fitness tracker to track their daily activities, heart rate, and sleep for 5 weeks. The internet-delivered CBT program included well-being prediction, activity and sleep chart, and sleep advice. A job-based multitask and multilabel convolutional neural network--based model was used for well-being prediction. Participant-specific sleep advice was provided by sleep physicians based on daily surveys and fitness tracker data. The primary end point of this study was sleep duration. For continuous measurements (sleep duration, steps, etc), the mean baseline and week-4 intervention data were compared. The 2-tailed paired t test or Wilcoxon signed rank test was performed depending on the distribution of the data. Results: In the fourth week of intervention, the mean daily sleep duration for 7 days (6.06, SD 1.30 hours) showed a statistically significant increase compared with the baseline (5.54, SD 1.36 hours; P=.02). Subjective sleep quality, as measured by the Pittsburgh Sleep Quality Index, also showed statistically significant improvement from baseline (9.10) to after the intervention (7.84; P=.001). However, no significant improvement was found in the subjective well-being scores (all P>.05). Feature importance analysis for all 45 variables in the prediction model showed that sleep duration had the highest importance. Conclusions: The physician-assisted internet-delivered CBT program targeting shift workers with a high risk of sleep disorders showed a statistically significant increase in sleep duration as measured by wearable sensors along with subjective sleep quality. This study shows that sleep improvement programs using an app and wearable sensors are feasible and may play an important role in preventing shift work--related sleep disorders. International Registered Report Identifier (IRRID): RR2-10.2196/24799. ",
doi="10.2196/45834",
url="https://www.jmir.org/2023/1/e45834",
url="http://www.ncbi.nlm.nih.gov/pubmed/37606971"
}


@Article{info:doi/10.2196/44745,
author="Zhou, Liying
and Deng, Xinxin
and Guo, Kangle
and Hou, Liangying
and Hui, Xu
and Wu, Yanan
and Xu, Meng
and Wang, Yongsheng
and Liang, Shanshan
and Yang, Kehu
and Li, Xiuxia",
title="Effectiveness of Multicomponent Interventions in Office-Based Workers to Mitigate Occupational Sedentary Behavior: Systematic Review and Meta-Analysis",
journal="JMIR Public Health Surveill",
year="2023",
month="Jul",
day="26",
volume="9",
pages="e44745",
keywords="sedentary behavior",
keywords="workplace",
keywords="multicomponent",
keywords="systematic review",
abstract="Background: Sedentary time in workplaces has been linked to increased risks of chronic occupational diseases, obesity, and overall mortality. Currently, there is a burgeoning research interest in the implementation of multicomponent interventions aimed at decreasing sedentary time among office workers, which encompass a comprehensive amalgamation of individual, organizational, and environmental strategies. Objective: This meta-analysis aims at evaluating the effectiveness of multicomponent interventions to mitigate occupational sedentary behavior at work compared with no intervention. Methods: PubMed, Web of Science, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from database inception until March 2023 to obtain randomized controlled trials (RCTs) assessing the efficacy of multicomponent interventions on occupational sedentary behavior among office-based workers. Two reviewers independently extracted the data and assessed the risk of bias by using the Cochrane Collaboration's risk of bias tool. The average intervention effect on sedentary time was calculated using Stata 15.1. Mean differences (MDs) with 95\% CIs were used to calculate the continuous variables. Subgroup analyses were performed to determine whether sit-stand workstation, feedback, and prompt elements played an important role in multicomponent interventions. Further, the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system was used to evaluate the certainty of evidence. Results: A total of 11 RCTs involving 1894 patients were included in the analysis. Five studies were rated as low risk of bias, 2 as unclear risk of bias, and 4 as high risk. The meta-analysis results showed that compared with no intervention, multicomponent interventions significantly reduced occupational sitting time (MD=--52.25 min/8-h workday, 95\% CI --73.06 to --31.44; P<.001) and occupational prolonged sitting time (MD=--32.63 min/8-h workday, 95\% CI --51.93 to --13.33; P=.001) and increased occupational standing time (MD=44.30 min/8-h workday, 95\% CI 23.11-65.48; P<.001), whereas no significant differences were found in occupational stepping time (P=.06). The results of subgroup analysis showed that compared with multicomponent interventions without installment of sit-stand workstations, multicomponent interventions with sit-stand workstation installment showed better effects for reducing occupational sitting time (MD=--71.95 min/8-h workday, 95\% CI --92.94 to --51.15), increasing occupational standing time (MD=66.56 min/8-h workday, 95\% CI 43.45-89.67), and reducing occupational prolonged sitting time (MD=--47.05 min/8-h workday, 95\% CI --73.66 to --20.43). The GRADE evidence summary showed that all 4 outcomes were rated as moderate certainty. Conclusions: Multicomponent interventions, particularly those incorporating sit-stand workstations for all participants, are effective at reducing workplace sedentary time. However, given their cost, further research is needed to understand the effectiveness of low-cost/no-cost multicomponent interventions. ",
doi="10.2196/44745",
url="https://publichealth.jmir.org/2023/1/e44745",
url="http://www.ncbi.nlm.nih.gov/pubmed/37494100"
}


@Article{info:doi/10.2196/44195,
author="Soares, Pontes Juliana
and Lopes, Hor{\'a}cio Rayssa
and Mendon{\c{c}}a, Souza Paula Beatriz de
and Silva, Vieira C{\'i}cera Renata Diniz
and Rodrigues, Martins Cl{\'a}udia Cristiane Filgueira
and Castro, de Janete Lima",
title="Use of the Maslach Burnout Inventory Among Public Health Care Professionals: Scoping Review",
journal="JMIR Ment Health",
year="2023",
month="Jul",
day="21",
volume="10",
pages="e44195",
keywords="burnout professional",
keywords="burnout",
keywords="health care professional",
keywords="health personnel",
keywords="health professionals",
keywords="Maslach Burnout Inventory",
keywords="mental health",
keywords="occupational health",
keywords="public health services",
keywords="public health",
keywords="workplace stress",
abstract="Background: Work can be considered a source of living, well-being, and socioeconomic development. When the work environment negatively influences individuals, it may trigger emotional disturbances, behavioral problems, chronic stress conditions, and illnesses such as burnout syndrome (BS). Recently, studies on BS have increased and placed a special focus on health care professionals. The prevalence of BS among health professionals is associated with their chronic exposure to human hardship and long working hours without proper rest. These factors have contributed to greater stress and high physical and emotional exhaustion levels. Objective: This study aims to identify and map studies using the Maslach Burnout Inventory (MBI) scale to identify burnout syndrome in health professionals working in public health services. Methods: This scoping review was developed based on the Joanna Briggs Institute (JBI) Reviewers Manual and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A total of 6 databases were searched to identify relevant studies: Embase, LILACS, MEDLINE or PubMed, PsycInfo, Scopus, and Web of Science. Gray literature was consulted on ProQuest Dissertations and Theses Global, Google Scholar, Brazilian Digital Library of Theses and Dissertations, and Open Access Theses and Dissertations. Additionally, the reference lists were searched to retrieve studies not previously selected. The steps followed in this study were proposed by Arskey and O'Malley and Levac, Colquhoun, and O'Brien: identification of research questions, identification of potential studies, study selection, data extraction and imputation, data analyses and interpretation, and consultation with stakeholders. The detailed methodology was published in a protocol. Results: A total of 55 articles were identified after screening for eligibility criteria, published between 1999 and 2021 in 32 countries. Most reports were published in Brazil, Spain, and China. A total of 22 versions of the MBI were identified, presenting different items, scores, and cutoff points. The included studies had recommendations and implications for clinical practice. The consultation with stakeholders allowed knowledge translation for those interested in BS. Conclusions: Studies mostly included physicians (34/55, 61.8\%) and nurses (24/55, 43.6\%), and the original version of MBI was predominantly used. Divergences in BS classification were highlighted, which may be related to MBI cross-cultural adaptations and applications in other countries. This study contributes to the advancement of research regarding burnout syndrome as an occupational illness since it has harmful consequences for workers, health care services, and the quality of care provided to the population. ",
doi="10.2196/44195",
url="https://mental.jmir.org/2023/1/e44195",
url="http://www.ncbi.nlm.nih.gov/pubmed/37477960"
}


@Article{info:doi/10.2196/48790,
author="H{\"o}per, Christina Anje
and Kirkeleit, Jorunn
and Thomassen, Renate Marte
and Irgens-Hansen, Kaja
and Hollund, Eli Bj{\o}rg
and Fagern{\ae}s, Fredrik Carl
and Svedahl, Rabben Sindre
and Eriksen, Eirik Thor
and Grgic, Miriam
and Bang, Elisabeth Berit",
title="Effects of Interventions to Prevent Work-Related Asthma, Allergy, and Other Hypersensitivity Reactions in Norwegian Salmon Industry Workers (SHInE): Protocol for a Pragmatic Allocated Intervention Trial and Related Substudies",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="19",
volume="12",
pages="e48790",
keywords="allergy",
keywords="bioaerosols",
keywords="exposure-response",
keywords="health promotion",
keywords="hypersensitivity",
keywords="occupational asthma",
keywords="occupational skin disease",
keywords="psychosocial work environment",
keywords="salmon processing industry",
abstract="Background: Workers in the salmon processing industry have an increased risk of developing respiratory diseases and other hypersensitivity responses due to occupational exposure to bioaerosols containing fish proteins and microorganisms, and related allergens. Little is known about effective measures to reduce bioaerosol exposure and about the extent of skin complaints among workers. In addition, while identification of risk factors is a core activity in disease prevention strategies, there is increasing interest in health-promoting factors, which is an understudied area in the salmon processing industry. Objective: The overall aim of this ongoing study is to generate knowledge that can be used in tailored prevention of development or chronification of respiratory diseases, skin reactions, protein contact dermatitis, and allergy among salmon processing workers. The main objective is to identify effective methods to reduce bioaerosol exposure. Further objectives are to identify and characterize clinically relevant exposure agents, identify determinants of exposure, measure prevalence of work-related symptoms and disease, and identify health-promoting factors of the psychosocial work environment. Methods: Data are collected during field studies in 9 salmon processing plants along the Norwegian coastline. Data collection comprises exposure measurements, health examinations, and questionnaires. A wide range of laboratory analyses will be used for further analysis and characterization of exposure agents. Suitable statistical analysis will be applied to the various outcomes of this comprehensive study. Results: Data collection started in September 2021 and was anticipated to be completed by March 2023, but was delayed due to the COVID-19 pandemic. Baseline data from all 9 plants included 673 participants for the health examinations and a total of 869 personal exposure measurements. A total of 740 workers answered the study's main questionnaire on demographics, job characteristics, lifestyle, health, and health-promoting factors. Follow-up data collection is not completed yet. Conclusions: This study will contribute to filling knowledge gaps concerning salmon workers' work environment. This includes effective workplace measures for bioaerosol exposure reduction, increased knowledge on hypersensitivity, allergy, respiratory and dermal health, as well as health-promoting workplace factors. Together this will give a basis for improving the work environment, preventing occupational health-related diseases, and developing occupational exposure limits, which in turn will benefit employees, employers, occupational health services, researchers, clinicians, decision makers, and other stakeholders. Trial Registration: ClinicalTrials.gov NCT05039229; https://www.clinicaltrials.gov/study/NCT05039229 International Registered Report Identifier (IRRID): DERR1-10.2196/48790 ",
doi="10.2196/48790",
url="https://www.researchprotocols.org/2023/1/e48790",
url="http://www.ncbi.nlm.nih.gov/pubmed/37467018"
}


@Article{info:doi/10.2196/47986,
author="Stevenson, Brian
and Teravainen, Taina
and Kathawalla, Kiram Ummul
and Singer, Margo
and Wilkins, Sarah
and Mueller, Lisa
and Kelly, Megan
and Ellison, Marsha
and Shirk, D. Steven
and Bakken, Shana
and Blustein, David",
title="Feasibility of a Career Development Intervention for Veterans in Vocational Rehabilitation: Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="30",
volume="12",
pages="e47986",
keywords="psychiatric disorders",
keywords="career development",
keywords="vocational rehabilitation",
keywords="randomized controlled trial",
keywords="transitional work",
keywords="veterans",
keywords="mental health",
keywords="employment",
abstract="Background: Veterans with psychiatric disorders want additional career development services to support their recovery and pursuit of meaningful employment. However, no career counseling programs have been designed for this specific population. We developed the Purposeful Pathways intervention to fill this need. Objective: This study protocol aims to (1) evaluate the feasibility and acceptability of the Purposeful Pathways intervention for veterans living with psychiatric disorders and (2) explore preliminary clinical outcome data. Methods: A total of 50 veterans who are participating in transitional work vocational rehabilitation services at a Veterans Affairs hospital will be randomized to either treatment as usual or the augmented treatment condition (treatment as usual plus Purposeful Pathways). Feasibility will be assessed via recruitment rates, clinician fidelity to treatment, retention rates, and acceptability of randomization procedures. Acceptability will be assessed via client satisfaction at treatment termination using quantitative and qualitative data collection. Preliminary clinical and vocational outcomes will be assessed at baseline, 6 weeks, 12 weeks (treatment termination), and a 3-month follow-up via quantitative measures assessing vocational functioning, vocational process, and mental and physical functioning. Results: This pilot randomized controlled trial is beginning recruitment in June 2023 and is expected to continue through November 2025. Data collection is expected to be completed by February 2026, with full data analysis completed by March 2026. Conclusions: Findings from this study will provide information on the feasibility and acceptability of the Purposeful Pathways intervention, as well as secondary outcomes related to vocational functioning, vocational process, and mental and physical functioning. Trial Registration: ClinicalTrials.gov NCT04698967; https://clinicaltrials.gov/ct2/show/NCT04698967 International Registered Report Identifier (IRRID): PRR1-10.2196/47986 ",
doi="10.2196/47986",
url="https://www.researchprotocols.org/2023/1/e47986",
url="http://www.ncbi.nlm.nih.gov/pubmed/37389915"
}


@Article{info:doi/10.2196/46431,
author="Obuobi-Donkor, Gloria
and Eboreime, Ejemai
and Shalaby, Reham
and Agyapong, Belinda
and Phung, Natalie
and Eyben, Scarlett
and Wells, Kristopher
and Dias, Luz Raquel da
and Hilario, Carla
and Jones, Chelsea
and Br{\'e}mault-Phillips, Suzette
and Zhang, Yanbo
and Greenshaw, J. Andrew
and Agyapong, Opoku Vincent Israel",
title="User Satisfaction With a Daily Supportive Text Message Program (Text4PTSI) for Public Safety Personnel: Longitudinal Cross-Sectional Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="23",
volume="7",
pages="e46431",
keywords="public safety personnel",
keywords="Text4PTSI",
keywords="text messaging",
keywords="satisfaction",
keywords="occupational health",
keywords="work safety",
keywords="public safety",
keywords="digital health intervention",
keywords="mental health service",
keywords="user satisfaction",
abstract="Background: Public safety personnel (PSP) are exposed to traumatic events due to their work environments, which increases the risk of mental health challenges. Providing effective and evidence-based interventions, such as SMS text messaging programs, can improve PSP's overall mental well-being with high user satisfaction rates. Objective: This study aims to evaluate users' satisfaction, receptiveness, and perceptions of a cognitive behavioral therapy (CBT)--based supportive SMS text messaging intervention (Text4PTSI). Methods: Participants self-subscribed to Text4PTSI and received unidirectional cognitive behavioral--based supportive text messages for 6 months. Participants completed a web-based survey delivered via SMS text message at enrollment, and 6 weeks, 3 months, and 6 months post enrollment. Respondents' perception and receptivity of the program were assessed using a questionnaire measured on a 5-point Likert scale. Data were collected as categorical variables, and overall satisfaction with the Text4PTSI program was measured on a scale from 0 to 100. Results: There were 131 subscribers to the Text4PTSI program; however, only 81 subscribers responded to the survey, producing 100 survey responses across the 3 follow-up time points. The overall mean score of satisfaction was 85.12 (SD 13.35). More than half of the survey responses agreed or strongly agreed that Text4PTSI helped participants cope with anxiety (79/100 responses, 79\%), depressive symptoms (72/100 responses, 72\%), and loneliness (54/100 responses, 54\%). Similarly, most of the survey responses agreed or strongly agreed that the Text4PTSI program made respondents feel connected to a support system, improved their overall mental well-being (84/100 responses, 84\%), felt more hopeful about managing concerns about their mental health or substance use (82 out of responses, 82\%), and helped enhance their overall quality of life (77/100 responses, 77\%). The available survey responses suggest that the majority always read the supportive text messages (84/100 responses, 84\%), took time to reflect on each message (75/100 responses, 75\%), and returned to read the text messages more than once (76/100 responses, 76\%). Conclusions: PSP who responded to the follow-up surveys reported high user satisfaction and appreciation for receiving the Text4PTSI intervention during the 6-month program. The reported satisfaction with the service provided could pave the way to ensuring a better uptake of the service with potential effectiveness to end users. ",
doi="10.2196/46431",
url="https://formative.jmir.org/2023/1/e46431",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351940"
}


@Article{info:doi/10.2196/44226,
author="Neil-Sztramko, E. Sarah
and Dobbins, Maureen
and Williams, Allison",
title="Evaluation of a Knowledge Mobilization Campaign to Promote Support for Working Caregivers in Canada: Quantitative Evaluation",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="22",
volume="7",
pages="e44226",
keywords="informal caregiver",
keywords="knowledge mobilization",
keywords="social media",
keywords="workplace standard",
abstract="Background: As population demographics continue to shift, many employees will also be tasked with providing informal care to a friend or family member. The balance between working and caregiving can greatly strain carer-employees. Caregiver-friendly work environments can help reduce this burden. However, there is little awareness of the benefits of these workplace practices, and they have not been widely adopted in Canada. An awareness-generating campaign with the core message ``supporting caregivers at work makes good business sense'' was created leading up to Canada's National Caregivers Day on April 5, 2022. Objective: Our primary objective is to describe the campaign's reach and engagement, including social media, email, and website activity, and our secondary objective is to compare engagement metrics across social media platforms. Methods: An awareness-generating campaign was launched on September 22, 2021, with goals to (1) build awareness about the need for caregiver-friendly workplaces and (2) direct employees and employers to relevant resources on a campaign website. Content was primarily delivered through 4 social media platforms (Twitter, LinkedIn, Facebook, and Instagram), and supplemented by direct emails through a campaign partner, and through webinars. Total reach, defined as the number of impressions, and quality of engagement, defined per social media platform as the engagement rate per post, average site duration, and page depth, were captured and compared through site-specific analytics on Facebook, Instagram, Twitter, and LinkedIn throughout the awareness-generating campaign. The number of views, downloads, bounce rate, and time on the page for the website were counted using Google Analytics. Open and click-through rates were measured using email analytics, and webinar registrants and attendees were also tracked. Results: Data were collected from September 22, 2021, to April 12, 2022. During this time, 30 key messages were developed and disseminated through 74 social media tiles. While Facebook posts generated the most extensive reach (137,098 impressions), the quality of the engagement was low (0.561 engagement per post). Twitter resulted in the highest percentage of impressions that resulted in engagement (24\%), and those who viewed resources through Twitter spent a substantial amount of time on the page (3 minute 5 second). Website users who visited the website through Instagram spent the most time on the website (5 minute 44 second) and had the greatest page depth (2.20 pages), and the overall reach was low (3783). Recipients' engagement with email content met industry standards. Webinar participation ranged from 57 to 78 attendees. Conclusions: This knowledge mobilization campaign reached a large audience and generated engagement in content. Twitter is most helpful for this type of knowledge mobilization. Further work is needed to evaluate the characteristics of individuals engaging in this content and to work more closely with employers and employees to move from engagement and awareness to adopt caregiver-friendly workplace practices. ",
doi="10.2196/44226",
url="https://formative.jmir.org/2023/1/e44226",
url="http://www.ncbi.nlm.nih.gov/pubmed/37347525"
}


@Article{info:doi/10.2196/40327,
author="Naranjo-Saucedo, Belen Ana
and Escobar-Rodriguez, Antonio German
and Tabernero, Carmen
and Cuadrado, Esther
and Parra-Calderon, Luis Carlos
and Arenas, Alicia",
title="Mobile Health Requirements for the Occupational Health Assessment of Health Care Professionals: Delphi Study",
journal="JMIR Form Res",
year="2023",
month="May",
day="31",
volume="7",
pages="e40327",
keywords="occupational health assessment",
keywords="psychosocial risks",
keywords="health care professionals",
keywords="mobile health",
keywords="mHealth",
keywords="Delphi method",
abstract="Background: In recent years, owing to the COVID-19 pandemic, awareness of the high level of stress among health care professionals has increased, and research in this area has intensified. Hospital staff members have historically been known to work in an environment involving high emotional demands, time pressure, and workload. Furthermore, the pandemic has increased the strain experienced by health care professionals owing to the high number of people they need to manage and, on many occasions, the limited available resources with which they must carry out their functions. These psychosocial risks are not always well dealt with by the organization or the professionals themselves. Therefore, it is necessary to have tools to assess these psychosocial risks and to optimize the management of this demand from health care professionals. Digital health, and more specifically, mobile health (mHealth), is presented as a health care modality that can contribute greatly to respond to these unmet needs. Objective: We aimed to analyze whether mHealth tools can provide value for the study and management of psychosocial risks in health care professionals, and assess the requirements of these tools. Methods: A Delphi study was carried out to determine the opinions of experts on the relevance of using mHealth tools to evaluate physiological indicators and psychosocial factors in order to assess occupational health, and specifically, stress and burnout, in health care professionals. The study included 58 experts with knowledge and experience in occupational risk prevention, psychosocial work, and health-related technology, as well as health professionals from private and public sectors. Results: Our data suggested that there is still controversy about the roles that organizations play in occupational risk prevention in general and psychosocial risks in particular. An adequate assessment of the stress levels and psychosocial factors can help improve employees' well-being. Moreover, making occupational health evaluations available to the team would positively affect employees by increasing their feelings of being taken into account by the organization. This assessment can be improved with mHealth tools that identify and quickly highlight the difficulties or problems that occur among staff and work teams. However, to achieve good adherence and participation in occupational health and safety evaluations, experts consider that it is essential to ensure the privacy of professionals and to develop feelings of being supported by their supervisors. Conclusions: For years, mHealth has been used mainly to propose intervention programs to improve occupational health. Our research highlights the usefulness of these tools for evaluating psychosocial risks in a preliminary and essential phase of approaches to improve the health and well-being of professionals in health care settings. The most urgent requirements these tools must meet are those aimed at protecting the confidentiality and privacy of measurements. ",
doi="10.2196/40327",
url="https://formative.jmir.org/2023/1/e40327",
url="http://www.ncbi.nlm.nih.gov/pubmed/37256659"
}


@Article{info:doi/10.2196/46114,
author="Lecours, Alexandra
and Hong, Nha Quan
and Maclure, Joanie
and B{\'e}dard-Mercier, Roxanne
and Vincent, Claude
and Boucher, Normand
and Lord, Marie-Mich{\`e}le",
title="Teleworking to Support Accommodation, Inclusion, and Health of Aging Workers: Protocol for a Study to Design, Validate, and Test a Reflective Application Guide",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="25",
volume="12",
pages="e46114",
keywords="aging workers",
keywords="health",
keywords="intervention",
keywords="qualitative research",
keywords="telecommute",
keywords="telework",
abstract="Background: Aging workers constitute a growing population in many countries and form an indispensable and qualified resource, especially in the context of the labor shortage. Despite work's many benefits for individuals, organizations, and societies, it also presents several risks and challenges that may lead to occupational injuries. Thus, rehabilitation professionals and managers working with this emerging and unique clientele during their return to work after an absence often lack the tools and skills to support them, especially in the changing world of work that includes the rise of telework. Indeed, as an increasingly present work arrangement, telework has the potential to be used as an accommodation modality that can facilitate inclusion and healthy participation in the workplace. However, the implications of this topic for aging workers require study. Objective: This paper presents the protocol of a study that aims to develop a reflective telework application guide to support the accommodation, inclusion, and health of aging workers after an absence from work. Specifically, this study will (1) explore the experience of aging workers, managers, and rehabilitation professionals regarding telework and its impact on accommodation, inclusion, and health; (2) use a validated logic model to design a reflective application guide; and (3) test and evaluate the guide. Methods: Following a 3-phase developmental research design, individual interviews with aging teleworkers, managers, and rehabilitation professionals will enable the collection of qualitative data to be used in generating a logic model of levers and good practices, leading to the creation of a reflective application guide. Validation of this guide by workers and managers to measure its acceptability and applicability in daily life will precede its implementation. Results: Data collection began in spring 2023 and initial results are expected in fall 2023. This study aims to generate a concrete tool---namely, the reflective telework application guide---that rehabilitation professionals could use to support managers and aging workers during their return to work through the healthy use of telework. All phases of the study include conducting dissemination activities to share the results of the project and increase its sustainability potential (ie, publication through social networks, podcasts, conferences, and scientific publications). Conclusions: As the first of its kind, this project aims to produce innovative impacts at several levels, including practical, scientific, and societal impacts. In addition, the results will provide healthy solutions to the labor shortage in a changing world of work, where digital and teleworking are becoming increasingly important. International Registered Report Identifier (IRRID): DERR1-10.2196/46114 ",
doi="10.2196/46114",
url="https://www.researchprotocols.org/2023/1/e46114",
url="http://www.ncbi.nlm.nih.gov/pubmed/37227762"
}


@Article{info:doi/10.2196/33492,
author="Andersen, Pizarro Judith
and Di Nota, Maria Paula
and Alavi, Nazanin
and Anderson, Gregory
and Bennell, Craig
and McGregor, Carolyn
and Ricciardelli, Rosemary
and Scott, Caroline Sarah
and Shipley, Peter
and Vincent, Lise Michelle",
title="A Biological Approach to Building Resilience and Wellness Capacity Among Police Exposed to Posttraumatic Stress Injuries: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="24",
volume="12",
pages="e33492",
keywords="posttraumatic stress injuries",
keywords="autonomic modulation training",
keywords="resilience",
keywords="wellness promotion",
keywords="public safety personnel",
keywords="police",
keywords="heart rate variability",
keywords="heart rate variability biofeedback",
keywords="respiratory sinus arrhythmia",
abstract="Background: Law enforcement officers are routinely exposed to hazardous, disturbing events that can impose severe stress and long-term psychological trauma. As a result, police and other public safety personnel (PSP) are at increased risk of developing posttraumatic stress injuries (PTSIs) and disruptions to the autonomic nervous system (ANS). ANS functioning can be objectively and noninvasively measured by heart rate (HR), heart rate variability (HRV), and respiratory sinus arrhythmia (RSA). Traditional interventions aimed at building resilience among PSP have not adequately addressed the physiological ANS dysregulations that lead to mental and physical health conditions, as well as burnout and fatigue following potential psychological trauma. Objective: In this study, we will investigate the efficacy of a web-based Autonomic Modulation Training (AMT) intervention on the following outcomes: (1) reducing self-reported symptoms of PTSI, (2) strengthening ANS physiological resilience and wellness capacity, and (3) exploring how sex and gender are related to baseline differences in psychological and biological PTSI symptoms and response to the AMT intervention. Methods: The study is comprised of 2 phases. Phase 1 involves the development of the web-based AMT intervention, which includes 1 session of baseline survey measures, 6 weekly sessions that integrate HRV biofeedback (HRVBF) training with meta-cognitive skill practice, and 1 session of follow-up survey measures. Phase 2 will use a cluster randomized control design to test the effectiveness of AMT on the following prepost outcomes: (1) self-report symptoms of PTSI and other wellness measures; (2) physiological indicators of health and resilience including resting HR, HRV, and RSA; and (3) the influence of sex and gender on other outcomes. Participants will be recruited for an 8-week study across Canada in rolling cohorts. Results: The study received grant funding in March 2020 and ethics approval in February 2021. Due to delays related to COVID-19, phase 1 was completed in December 2022, and phase 2 pilot testing began in February 2023. Cohorts of 10 participants in the experimental (AMT) and control (prepost assessment only) groups will continue until a total of 250 participants are tested. Data collection from all phases is expected to conclude in December 2025 but may be extended until the intended sample size is reached. Quantitative analyses of psychological and physiological data will be conducted in conjunction with expert coinvestigators. Conclusions: There is an urgent need to provide police and PSP with effective training that improves physical and psychological functioning. Given that help-seeking for PTSI is reduced among these occupational groups, AMT is a promising intervention that can be completed in the privacy of one's home. Importantly, AMT is a novel program that uniquely addresses the underlying physiological mechanisms that support resilience and wellness promotion and is tailored to the occupational demands of PSP. Trial Registration: ClinicalTrials.gov NCT05521360; https://clinicaltrials.gov/ct2/show/NCT05521360 International Registered Report Identifier (IRRID): PRR1-10.2196/33492 ",
doi="10.2196/33492",
url="https://www.researchprotocols.org/2023/1/e33492",
url="http://www.ncbi.nlm.nih.gov/pubmed/37223981"
}


@Article{info:doi/10.2196/40818,
author="Gajewski, D. Patrick
and Rieker, A. Jennifer
and Athanassiou, Georgios
and Br{\"o}de, Peter
and Claus, Maren
and Golka, Klaus
and Hengstler, G. Jan
and Kleinsorge, Thomas
and Nitsche, A. Michael
and Reinders, J{\"o}rg
and Tisch, Anita
and Watzl, Carsten
and Wascher, Edmund
and Getzmann, Stephan",
title="A Systematic Analysis of Biological, Sociodemographic, Psychosocial, and Lifestyle Factors Contributing to Work Ability Across the Working Life Span: Cross-sectional Study",
journal="JMIR Form Res",
year="2023",
month="May",
day="19",
volume="7",
pages="e40818",
keywords="aging",
keywords="cognitive aging",
keywords="cardiovascular system",
keywords="immunology",
keywords="lifestyle",
keywords="metabolism",
keywords="occupational safety and health",
keywords="public health",
keywords="psychosocial stress",
keywords="work ability",
keywords="mobile phone",
abstract="Background: As employees age, their physical and mental abilities decline and work ability decreases, enhancing the risk for long-term sick leave or even premature retirement. However, the relative impact of biological and environmental determinants on work ability with increasing age is poorly understood in terms of their complexity. Objective: Previous research has shown relationships between work ability and job and individual resources, as well as specific demographic and lifestyle-related variables. However, other potentially important predictors of work ability remain unexplored, such as personality traits and biological determinants, including cardiovascular, metabolic, immunological, and cognitive abilities or psychosocial factors. Our aim was to systematically evaluate a wide range of factors to extract the most crucial predictors of low and high work ability across the working life span. Methods: As part of the Dortmund Vital Study, 494 participants from different occupational sectors, aged between 20 and 69 years, completed the Work Ability Index (WAI) assessing employee's mental and physical resources. A total of 30 sociodemographic variables were grouped into 4 categories (social relationships, nutrition and stimulants, education and lifestyle, and work related), and 80 biological and environmental variables were grouped into 8 domains (anthropometric, cardiovascular, metabolic, immunologic, personality, cognitive, stress related, and quality of life) and have been related to the WAI. Results: Using the analyses, we extracted important sociodemographic factors influencing work ability, such as education, social activities, or sleep quality, and identified age-dependent and age-independent determinants of work ability. Regression models explained up to 52\% of the WAI variance. Negative predictors of work ability were chronological and immunological age, immunological inefficiency, BMI, neuroticism, psychosocial stress, emotional exhaustion, demands from work, daily cognitive failures, subclinical depression, and burnout symptoms. Positive predictors were maximum heart rate during ergometry, normal blood pressure, hemoglobin and monocyte concentration, weekly physical activity, commitment to the company, pressure to succeed, and good quality of life. Conclusions: The identified biological and environmental risk factors allowed us to evaluate work ability in its complexity. Policy makers, employers, and occupational safety and health personnel should consider the modifiable risk factors we identified to promote healthy aging at work through focused physical, dietary, cognitive, and stress-reduced preventive programs, in addition to well-balanced working conditions. This may also increase the quality of life, commitment to the job, and motivation to succeed, which are important factors to maintain or even enhance work ability in the aging workforce and to prevent early retirement. Trial Registration: ClinicalTrials.gov NCT05155397; https://clinicaltrials.gov/ct2/show/NCT05155397 International Registered Report Identifier (IRRID): RR2-10.2196/32352 ",
doi="10.2196/40818",
url="https://formative.jmir.org/2023/1/e40818",
url="http://www.ncbi.nlm.nih.gov/pubmed/37204831"
}


@Article{info:doi/10.2196/43018,
author="Arguello, Diego
and Cloutier, Gregory
and Thorndike, N. Anne
and Castaneda Sceppa, Carmen
and Griffith, John
and John, Dinesh",
title="Impact of Sit-to-Stand and Treadmill Desks on Patterns of Daily Waking Physical Behaviors Among Overweight and Obese Seated Office Workers: Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="May",
day="16",
volume="25",
pages="e43018",
keywords="prolonged sedentary behavior",
keywords="sedentary behavior",
keywords="sit-to-stand desks",
keywords="treadmill desks",
keywords="physical activity promotion",
keywords="workplace wellness",
keywords="seated office workers",
keywords="move more and sit less",
abstract="Background: Sit-to-stand and treadmill desks may help sedentary office workers meet the physical activity guideline to ``move more and sit less,'' but little is known about their long-term impact on altering the accumulation patterns of physical behaviors. Objective: This study explores the impact of sit-to-stand and treadmill desks on physical behavior accumulation patterns during a 12-month multicomponent intervention with an intent-to-treat design in overweight and obese seated office workers. Methods: In total, 66 office workers were cluster randomized into a seated desk control (n=21, 32\%; 8 clusters), sit-to-stand desk (n=23, 35\%; 9 clusters), or treadmill desk (n=22, 33\%; 7 clusters) group. Participants wore an activPAL (PAL Technologies Ltd) accelerometer for 7 days at baseline, 3-month follow-up (M3), 6-month follow-up (M6), and 12-month follow-up (M12) and received periodic feedback on their physical behaviors. Analyses of physical behavior patterns included total day and workday number of sedentary, standing, and stepping bouts categorized into durations ranging from 1 to 60 and >60 minutes and usual sedentary, standing, and stepping bout durations. Intervention trends were analyzed using random-intercept mixed linear models accounting for repeated measures and clustering effects. Results: The treadmill desk group favored prolonged sedentary bouts (>60 min), whereas the sit-to-stand desk group accrued more short-duration sedentary bouts (<20 min). Therefore, compared with controls, sit-to-stand desk users had shorter usual sedentary bout durations short-term (total day $\Delta$M3: ?10.1 min/bout, 95\% CI ?17.9 to ?2.2; P=.01; workday $\Delta$M3: ?20.3 min/bout, 95\% CI ?37.7 to ?2.9; P=.02), whereas treadmill desk users had longer usual sedentary bout durations long-term (total day $\Delta$M12: 9.0 min/bout, 95\% CI 1.6-16.4; P=.02). The treadmill desk group favored prolonged standing bouts (30-60 min and >60 min), whereas the sit-to-stand desk group accrued more short-duration standing bouts (<20 min). As such, relative to controls, treadmill desk users had longer usual standing bout durations short-term (total day $\Delta$M3: 6.9 min/bout, 95\% CI 2.5-11.4; P=.002; workday $\Delta$M3: 8.9 min/bout, 95\% CI 2.1-15.7; P=.01) and sustained this long-term (total day $\Delta$M12: 4.5 min/bout, 95\% CI 0.7-8.4; P=.02; workday $\Delta$M12: 5.8 min/bout, 95\% CI 0.9-10.6; P=.02), whereas sit-to-stand desk users showed this trend only in the long-term (total day $\Delta$M12: 4.2 min/bout, 95\% CI 0.1-8.3; P=.046). The treadmill desk group accumulated more stepping bouts across various bins of duration (5-50 min), primarily at M3. Thus, treadmill desk users had longer usual stepping bout durations in the short-term compared with controls (workday $\Delta$M3: 4.8 min/bout, 95\% CI 1.3-8.3; P=.007) and in the short- and long-term compared with sit-to-stand desk users (workday $\Delta$M3: 4.7 min/bout, 95\% CI 1.6-7.8; P=.003; workday $\Delta$M12: 3.0 min/bout, 95\% CI 0.1-5.9; P=.04). Conclusions: Sit-to-stand desks exerted potentially more favorable physical behavior accumulation patterns than treadmill desks. Future active workstation trials should consider strategies to promote more frequent long-term movement bouts and dissuade prolonged static postural fixity. Trial Registration: ClinicalTrials.gov NCT02376504; https://clinicaltrials.gov/ct2/show/NCT02376504 ",
doi="10.2196/43018",
url="https://www.jmir.org/2023/1/e43018",
url="http://www.ncbi.nlm.nih.gov/pubmed/37191995"
}


@Article{info:doi/10.2196/43637,
author="Lopes, M{\'a}rio
and Lopes, Susana
and Monteiro, Mariana
and Rodrigues, M{\'a}rio
and Fertuzinhos, Aureliano
and Coelho, Sousa Augusto de
and Matos, Paulo
and Borges, Ab{\'i}lio
and Leite, Te{\'o}filo
and Sampaio, C{\'a}tia
and Costa, Rui
and Alvarelh{\~a}o, Jos{\'e}",
title="Exploring the Efficacy of a Set of Smart Devices for Postural Awareness for Workers in an Industrial Context: Protocol for a Single-Subject Experimental Design",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="4",
volume="12",
pages="e43637",
keywords="smart wear",
keywords="smart health",
keywords="occupational safety",
keywords="motion sensing",
keywords="devices",
keywords="awareness",
keywords="posture",
keywords="fatigue",
keywords="biomechanics",
keywords="musculoskeletal disorder",
keywords="smart device",
keywords="pressure sensing",
abstract="Background: In manufacturing industries, tasks requiring poor posture, high repetition, and long duration commonly induce fatigue and lead to an increased risk of work-related musculoskeletal disorders. Smart devices assessing biomechanics and providing feedback to the worker for correction may be a successful way to increase postural awareness, reducing fatigue, and work-related musculoskeletal disorders. However, evidence in industrial settings is lacking. Objective: This study protocol aims to explore the efficacy of a set of smart devices to detect malposture and increase postural awareness, reducing fatigue, and musculoskeletal disorders. Methods: A longitudinal single-subject experimental design following the ABAB sequence will be developed in a manufacturing industry real context with 5 workers. A repetitive task of screw tightening of 5 screws in a standing position into a piece placed horizontally was selected. Workers will be assessed in 4 moments per shift (10 minutes after the beginning of the shift, 10 minutes before and after the break, and 10 minutes before the end of the shift) in 5 nonconsecutive days. The primary outcomes are fatigue, assessed by electromyography, and musculoskeletal symptoms assessed by the Nordic Musculoskeletal Questionnaire. Secondary outcomes include perceived effort (Borg perceived exertion scale); range of motion of the main joints in the upper body, speed, acceleration, and deceleration assessed by motion analysis; risk stratification of range of motion; and cycle duration in minutes. Structured visual analysis techniques will be conducted to observe the effects of the intervention. Results for each variable of interest will be compared among the different time points of the work shift and longitudinally considering each assessment day as a time point. Results: Enrollment for the study will start in April 2023. Results are expected to be available still in the first semester of 2023. It is expected that the use of the smart system will reduce malposture, fatigue, and consequently, work-related musculoskeletal pain and disorders. Conclusions: This proposed study will explore a strategy to increase postural awareness in industrial manufacturing workers who do repetitive tasks, using smart wearables that provide real-time feedback about biomechanics. Results would showcase a novel approach for improving self-awareness of risk for work-related musculoskeletal disorders for these workers providing an evidence base support for the use of such devices. International Registered Report Identifier (IRRID): PRR1-10.2196/43637 ",
doi="10.2196/43637",
url="https://www.researchprotocols.org/2023/1/e43637",
url="http://www.ncbi.nlm.nih.gov/pubmed/37140979"
}


@Article{info:doi/10.2196/34446,
author="Persson Asplund, Robert
and Asplund, Sofia
and von Buxhoeveden, Helene
and Delby, Hanna
and Eriksson, Karin
and Svenning Gerhardsson, Maurits
and Palm, Joachim
and Skyttberg, Thea
and Torstensson, Julia
and Lj{\'o}tsson, Brj{\'a}nn
and Carlbring, Per
and Andersson, Gerhard",
title="Work-Focused Versus Generic Internet-Based Interventions for Employees With Stress-Related Disorders: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="25",
volume="25",
pages="e34446",
keywords="stress",
keywords="burnout",
keywords="exhaustion",
keywords="work-focused",
keywords="internet-based",
keywords="intervention",
keywords="sickness absence",
abstract="Background: In recent decades, stress-related disorders have received more attention, with an increasing prevalence, especially within the working population. The internet provides new options for broad dissemination, and a growing body of evidence suggests that web-based interventions for stress might be effective. However, few studies have examined the efficacy of interventions in clinical samples and work-related outcomes. Objective: The aim of this study was to evaluate the efficacy of an internet-based cognitive behavioral intervention for stress-related disorders integrating work-related aspects (work-focused and internet-based cognitive behavioral therapy [W-iCBT]), compared with a generic internet-based cognitive behavioral therapy (iCBT) group and a waitlist control (WLC) group. Methods: In this trial, 182 employees, mainly employed in the health care, IT, or educational sector, who fulfilled the criteria for a stress-related disorder, were randomized to a 10-week W-iCBT (n=61, 33.5\%), generic iCBT (n=61, 33.5\%), or WLC (n=60, 33\%). Self-rated questionnaires on perceived stress, burnout, exhaustion, and other mental health-- and work-related outcomes were administered before and after the treatment and at 6- and 12-month follow-ups. Results: Compared with the WLC group, participants of the W-iCBT and iCBT groups showed an equal and significant reduction in the primary outcome (Shirom-Melamed Burnout Questionnaire [SMBQ]) from pretreatment to posttreatment assessment (Cohen d=1.00 and 0.83, respectively) and at the 6-month follow-up (Cohen d=0.74 and 0.74, respectively). Significant moderate-to-large effect sizes were also found in the secondary health- and work-related outcomes. The W-iCBT was the only group that exhibited significant effects on work ability and short-term sickness absence. Short-term sickness absence was 445 days lower than the WLC group and 324 days lower than the iCBT intervention group. However, no significant differences were found in terms of work experience or long-term sick leave. Conclusions: The work-focused and generic iCBT interventions proved to be superior compared with the control condition in reducing chronic stress and several other mental health--related symptoms. Interestingly, effects on work ability and short-term sickness absence were only seen between the W-iCBT intervention and the WLC groups. These preliminary results are promising, indicating that treatments that include work aspects may have the potential to accelerate recovery and reduce short-term sickness absence because of stress-related disorders. Trial Registration: ClinicalTrials.gov NCT05240495; https://clinicaltrials.gov/ct2/show/NCT05240495 (retrospectively registered) ",
doi="10.2196/34446",
url="https://www.jmir.org/2023/1/e34446",
url="http://www.ncbi.nlm.nih.gov/pubmed/37097739"
}


@Article{info:doi/10.2196/37671,
author="Bian, Dongsheng
and Xiao, Yuyin
and Song, Keyu
and Dong, Minye
and Li, Li
and Millar, Ross
and Shi, Chenshu
and Li, Guohong",
title="Determinants Influencing the Adoption of Internet Health Care Technology Among Chinese Health Care Professionals: Extension of the Value-Based Adoption Model With Burnout Theory",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="10",
volume="25",
pages="e37671",
keywords="internet health care technology",
keywords="value-based adoption model",
keywords="employee burnout",
keywords="China",
keywords="health care",
keywords="health care workers",
keywords="internet",
keywords="technology",
keywords="cross-sectional study",
keywords="burnout",
keywords="internet hospitals",
abstract="Background: The global COVID-19 pandemic has been widely regarded as a catalyst for adopting internet health care technology (IHT) in China. IHT consists of new health care technologies that are shaping health services and medical consultations. Health care professionals play a substantial role in the adoption of any IHT, but the consequences of doing so can often be challenging, particularly when employee burnout is prevalent. Few studies have explored whether employee burnout influences the adoption intention of IHT in health care professionals. Objective: This study aims to explain the determinants influencing the adoption of IHT from the perspective of health care professionals. To do so, the study extends the value-based adoption model (VAM) with consideration for employee burnout as a determining factor. Methods: A cross-sectional web-based survey using a sample of 12,031 health care professionals selected through multistage cluster sampling from 3 provinces in mainland China was conducted. The hypotheses of our research model were developed based on the VAM and employee burnout theory. Structural equation modeling was then used to test the research hypotheses. Results: The results indicate that perceived usefulness, perceived enjoyment, and perceived complexity positively correlate with perceived value ($\beta$=.131, P=.01; $\beta$=.638, P<.001; $\beta$=.198, P<.001, respectively). Perceived value had a positive direct effect on adoption intention ($\beta$=.725, P<.001), perceived risk negatively correlated with perceived value ($\beta$=?.083, P<.001), and perceived value negatively correlated with employee burnout ($\beta$=?.308, P<.001). In addition, employee burnout was negatively related to adoption intention ($\beta$=?.170, P<.001) and mediated the relationship between perceived value and adoption intention ($\beta$=.052, P<.001). Conclusions: Perceived value, perceived enjoyment, and employee burnout were the most important determinants of IHT adoption intention by health care professionals. In addition, while employee burnout was negatively related to adoption intention, perceived value inhibited employee burnout. Therefore, this study finds that it is necessary to develop strategies to improve the perceived value and reduce employee burnout, which will benefit the promotion of the adoption intention of IHT in health care professionals. This study supports the use of the VAM and employee burnout in explaining health care professionals' adoption intention regarding IHT. ",
doi="10.2196/37671",
url="https://www.jmir.org/2023/1/e37671",
url="http://www.ncbi.nlm.nih.gov/pubmed/36897630"
}


@Article{info:doi/10.2196/34331,
author="Lentferink, Aniek
and Oldenhuis, Hilbrand
and Velthuijsen, Hugo
and van Gemert-Pijnen, Lisette",
title="How Reflective Automated e-Coaching Can Help Employees Improve Their Capacity for Resilience: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2023",
month="Mar",
day="10",
volume="10",
pages="e34331",
keywords="self-reflection",
keywords="stress management",
keywords="resilience",
keywords="eHealth",
keywords="self-tracking",
keywords="e-Coaching",
keywords="mobile phone",
abstract="Background: An eHealth tool that coaches employees through the process of reflection has the potential to support employees with moderate levels of stress to increase their capacity for resilience. Most eHealth tools that include self-tracking summarize the collected data for the users. However, users need to gain a deeper understanding of the data and decide upon the next step to take through self-reflection. Objective: In this study, we aimed to examine the perceived effectiveness of the guidance offered by an automated e-Coach during employees' self-reflection process in gaining insights into their situation and on their perceived stress and resilience capacities and the usefulness of the design elements of the e-Coach during this process. Methods: Of the 28 participants, 14 (50\%) completed the 6-week BringBalance program that allowed participants to perform reflection via four phases: identification, strategy generation, experimentation, and evaluation. Data collection consisted of log data, ecological momentary assessment (EMA) questionnaires for reflection provided by the e-Coach, in-depth interviews, and a pre- and posttest survey (including the Brief Resilience Scale and the Perceived Stress Scale). The posttest survey also asked about the utility of the elements of the e-Coach for reflection. A mixed methods approach was followed. Results: Pre- and posttest scores on perceived stress and resilience were not much different among completers (no statistical test performed). The automated e-Coach did enable users to gain an understanding of factors that influenced their stress levels and capacity for resilience (identification phase) and to learn the principles of useful strategies to improve their capacity for resilience (strategy generation phase). Design elements of the e-Coach reduced the reflection process into smaller steps to re-evaluate situations and helped them to observe a trend (identification phase). However, users experienced difficulties integrating the chosen strategies into their daily life (experimentation phase). Moreover, the identified events related to stress and resilience were too specific through the guidance offered by the e-Coach (identification phase), and the events did not recur, which consequently left users unable to sufficiently practice (strategy generation phase), experiment (experimentation phase), and evaluate (evaluation phase) the techniques during meaningful events. Conclusions: Participants were able to perform self-reflection under the guidance of the automated e-Coach, which often led toward gaining new insights. To improve the reflection process, more guidance should be offered by the e-Coach that would aid employees to identify events that recur in daily life. Future research could study the effects of the suggested improvements on the quality of reflection via an automated e-Coach. ",
doi="10.2196/34331",
url="https://humanfactors.jmir.org/2023/1/e34331",
url="http://www.ncbi.nlm.nih.gov/pubmed/36897635"
}


@Article{info:doi/10.2196/42239,
author="Jahan, Ishrat
and Dalal, Koustuv
and Khan, Saeed Md Abdullah
and Mutsuddi, Archi
and Sultana, Sabeeha
and Rashid, Utba Md
and Haque, Akiful Miah Md
and Hossain, Ali Mohammad
and Hossian, Mosharop
and Nabi, Hayatun Mohammad
and Hawlader, Hossain Mohammad Delwer",
title="Occupational Health Hazards Among Traffic Police in South Asian Countries: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="8",
volume="12",
pages="e42239",
keywords="traffic police",
keywords="occupational health hazards",
keywords="occupational injuries",
keywords="occupational exposures",
keywords="South Asia",
keywords="occupational",
keywords="injury",
keywords="psychosocial",
keywords="well-being",
keywords="prevention",
keywords="database",
keywords="policy",
abstract="Background: Occupational health hazards and injuries are an alarming concern among traffic police. Occupational injuries affect the physical, social, and mental well-being of police personnel, which has various public health implications. The evaluation of occupational health and safety policies and regulations for the traffic police relies on their occupational exposure and health hazard statistics and assessments. Objective: The purpose of this scoping review is to systematically explore, analyze, and describe relevant findings from all studies conducted on occupational exposure and associated health hazards among traffic police in South Asia. Methods: The scoping review will include studies that assessed occupational exposure prevalence, types, knowledge, predisposing factors, and prevention strategies. Databases like PubMed, Springer Link, EBSCOhost, the Cochrane library, and Google Scholar will be used to obtain both published and unpublished works in the English language. Relevant gray literature, including governmental and international organization reports, will be examined. After removing duplicates and screening titles and abstracts, the full-text analysis will begin. Arksey and O'Malley's methodology framework for scoping reviews will be followed. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, the scoping review will be reported. Two qualified reviewers will independently conduct article screening and data extraction. The extracted data will then be tabulated and accompanied by an explanation to facilitate comprehension. We will extract relevant article results using NVivo (version 10; QSR International) and thematic content analysis. The included articles will be evaluated using the mixed methods appraisal tool (version 2018). Results: The scoping review will provide insight into how occupational health hazards affect traffic police physically and psychologically in South Asia. The theoretical conceptualization of different aspects of the occupational health of traffic police will emphasize future studies in this region, which will inform policy makers to revise their occupational health and safety policies and principles. It will have implications for taking necessary preventive measures in the future to reduce occupational injuries and fatalities resulting from different types of occupational hazards. Conclusions: This scoping review will describe the overview of occupational hazards among South Asian traffic police and will provide insights for policy makers to implement changes and to adapt new strategies. International Registered Report Identifier (IRRID): PRR1-10.2196/42239 ",
doi="10.2196/42239",
url="https://www.researchprotocols.org/2023/1/e42239",
url="http://www.ncbi.nlm.nih.gov/pubmed/36884285"
}


@Article{info:doi/10.2196/41230,
author="Lovegrove, J. Christopher
and Marsden, Jonathan
and Smith, Mary
and Sturkenboom, Ingrid
and Bannigan, Katrina",
title="Characteristics of Occupational Therapy Interventions for Community-Dwelling Adults With Anxiety: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="1",
volume="12",
pages="e41230",
keywords="occupational therapy",
keywords="anxiety",
keywords="adult",
keywords="health",
keywords="activities of daily living",
keywords="therapy",
keywords="intervention",
keywords="community",
keywords="life quality",
keywords="well-being",
keywords="quality of life",
keywords="support",
keywords="development",
keywords="research",
abstract="Background: Anxiety is linked to decreased life quality and well-being. Living with an anxiety disorder results in higher personal and societal financial expenditure. Occupational therapists work with people living with anxiety in a variety of settings. A preliminary database search was conducted, and no current or underway systematic or scoping reviews on the topic were identified. Developing an overview of studies of occupational therapy interventions for people with anxiety is a necessary first step to understanding the existing knowledge and to increase the impact of future interventions. This scoping review will build on the findings of a previously conducted systematic review. Objective: This scoping review will identify the following: (1) what occupational therapy interventions exist for adults with anxiety and (2) the intervention characteristics including outcomes used and impact observed. Methods: This protocol was reviewed by an occupational therapist as part of a patient and public involvement consultation. The review will consider all studies and publications of occupational therapy that include community-dwelling adults with a diagnosis of anxiety who are aged 18 years and older and diagnosed with an anxiety disorder (Diagnostic and Statistical Manual of Mental Disorders [DSM-5-TR] criteria). Databases to be searched are MEDLINE, CINAHL, Cochrane Library, Science Direct, PsycArticles, Psychology \& Behavioural Sciences Collection, Embase, PubMed, TRIP, Proquest, Social Care Online, JBI EBP database, OpenGrey, and OALster. Titles and abstracts will be screened against the inclusion criteria using Rayyan Qatar Computing Research Institute. Potentially relevant studies will be retrieved in full and assessed against the inclusion criteria. Articles published in English will be included. No date limiters will be used. Study selection will be completed by 2 independent reviewers. Data will be extracted using a data extraction tool. Results: Data will be charted using the Template for Intervention Description and Replication (TIDieR) checklist in alignment with the review objectives. The scoping review will be reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols statement. Conclusions: This scoping review will produce valuable information about community-based interventions used to improve participation, life quality, and well-being for adults with anxiety to support the development of occupational therapy interventions. The findings will be disseminated through professional and National Health Service bodies, employer organizations, conferences, and research articles. The findings will be of value to health care professionals and researchers working to improve the lives of people living with anxiety. Trial Registration: Open Science Framework DOI 10.17605/OSF.IO/JS549; https://osf.io/js549/ International Registered Report Identifier (IRRID): DERR1-10.2196/41230 ",
doi="10.2196/41230",
url="https://www.researchprotocols.org/2023/1/e41230",
url="http://www.ncbi.nlm.nih.gov/pubmed/36857111"
}


@Article{info:doi/10.2196/43502,
author="Huang, Yitong
and Benford, Steve
and Li, Benqian
and Price, Dominic
and Blake, Holly",
title="Feasibility and Acceptability of an Internet of Things--Enabled Sedentary Behavior Intervention: Mixed Methods Study",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="27",
volume="25",
pages="e43502",
keywords="internet of things",
keywords="health communication",
keywords="pervasive media",
keywords="ubiquitous computing",
keywords="smart objects",
keywords="wearable device",
keywords="behavior change wheel",
keywords="digital intervention",
keywords="sedentary behavior",
keywords="workplace intervention",
keywords="employee well-being",
abstract="Background: Encouraging office workers to break up prolonged sedentary behavior (SB) at work with regular microbreaks can be beneficial yet challenging. The Internet of Things (IoT) offers great promise for delivering more subtle and hence acceptable behavior change interventions in the workplace. We previously developed an IoT-enabled SB intervention, called WorkMyWay, by applying a combination of theory-informed and human-centered design approaches. According to the Medical Research Council's framework for developing and evaluating complex interventions such as WorkMyWay, process evaluation in the feasibility phase can help establish the viability of novel modes of delivery and identify facilitators and barriers to successful delivery. Objective: This study aims to evaluate the feasibility and acceptability of the WorkMyWay intervention and its technological delivery system. Methods: A mixed methods approach was adopted. A sample of 15 office workers were recruited to use WorkMyWay during work hours for 6 weeks. Questionnaires were administered before and after the intervention period to assess self-report occupational sitting and physical activity (OSPA) and psychosocial variables theoretically aligned with prolonged occupational SB (eg, intention, perceived behavioral control, prospective memory and retrospective memory of breaks, and automaticity of regular break behaviors). Behavioral and interactional data were obtained through the system database to determine adherence, quality of delivery, compliance, and objective OSPA. Semistructured interviews were conducted at the end of the study, and a thematic analysis was performed on interview transcripts. Results: All 15 participants completed the study (attrition=0\%) and on average used the system for 25 tracking days (out of a possible 30 days; adherence=83\%). Although no significant change was observed in either objective or self-report OSPA, postintervention improvements were significant in the automaticity of regular break behaviors (t14=2.606; P=.02), retrospective memory of breaks (t14=7.926; P<.001), and prospective memory of breaks (t14=--2.661; P=.02). The qualitative analysis identified 6 themes, which lent support to the high acceptability of WorkMyWay, though delivery was compromised by issues concerning Bluetooth connectivity and factors related to user behaviors. Fixing technical issues, tailoring to individual differences, soliciting organizational supports, and harnessing interpersonal influences could facilitate delivery and enhance acceptance. Conclusions: It is acceptable and feasible to deliver an SB intervention with an IoT system that involves a wearable activity tracking device, an app, and a digitally augmented everyday object (eg, cup). More industrial design and technological development work on WorkMyWay is warranted to improve delivery. Future research should seek to establish the broad acceptability of similar IoT-enabled interventions while expanding the range of digitally augmented objects as the modes of delivery to meet diverse needs. ",
doi="10.2196/43502",
url="https://www.jmir.org/2023/1/e43502",
url="http://www.ncbi.nlm.nih.gov/pubmed/36848183"
}


@Article{info:doi/10.2196/43771,
author="Henshall, Catherine
and Davey, Zoe
and Srikesavan, Cynthia
and Hart, Liam
and Butcher, Dan
and Cipriani, Andrea",
title="Implementation of a Web-Based Resilience Enhancement Training for Nurses: Pilot Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="14",
volume="25",
pages="e43771",
keywords="burnout",
keywords="COVID-19",
keywords="health care setting",
keywords="health care staff",
keywords="health care provider",
keywords="mental health",
keywords="mental well-being",
keywords="nurses",
keywords="nursing",
keywords="pilot trial",
keywords="psychological health",
keywords="resilience training",
keywords="resilience",
keywords="web-based health",
keywords="web-based training",
abstract="Background: Global workforce challenges faced by health care providers are linked to low levels of job satisfaction, recruitment, retention, and well-being, with detrimental impacts on patient care outcomes. Resilience-building programs can provide support for staff who endure highly stressful environments, enhance resilience, and support recruitment and retention, with web-based formats being key to increasing accessibility. Objective: We aimed to examine participants' engagement with a newly developed Resilience Enhancement Online Training for Nurses (REsOluTioN), explore its acceptability, and compare levels of resilience and psychological well-being in nurses who completed REsOluTioN with those who did not. Methods: We carried out a pilot randomized trial (1:1), conducted at a single site (mental health and community trust in South England) between August 2021 and May 2022. Local research ethics approvals were obtained. Nurses were invited to participate and were randomly assigned to a waitlist group or REsOluTioN group. Training lasted for 4 weeks, consisting of prereading, web-based facilitated sessions, and mentorship support. We evaluated trial engagement, acceptability of training, and pre-post changes in resilience, measured by the Brief Resilience Scale, and psychological well-being, measured by the Warwick Edinburgh Mental Wellbeing Scale. Qualitative participant feedback was collected. Consolidated Standards of Reporting Trials 2010 extension guidelines for reporting pilot and feasibility trials were used. Results: Of 108 participants recruited, 93 completed the study. Participants' mean age was 44 (SD 10.85) years. Most participants were female (n=95, 88.8\%), White (n=95, 88.8\%), and worked in community settings (n=91, 85.0\%). Sixteen facilitated and 150 mentoring sessions took place. Most REsOluTioN program participants reported the sessions helped improve their resilience (n=24, 72.8\%), self-confidence (n=24, 72.7\%), ability to provide good patient care (n=25, 75.8\%), relationships with colleagues (n=24, 72.7\%), and communication skills (n=25, 75.8\%). No statistically significant differences between training and control groups and time on well-being (F1,91=1.44, P=.23, partial $\eta$2=0.02) and resilience scores (F1,91=0.33, P=.57, partial $\eta$2=0.004) were revealed; however, there were positive trends toward improvement in both. Nurse participants engaged with the REsOluTioN program and found it acceptable. Most found web-based training and mentoring useful and enjoyed learning, reflection, networking, and participatory sessions. Conclusions: The REsOluTioN program was acceptable, engaging, perceived as useful, and nurses were keen for it to be implemented to optimize resilience, psychological health, communication, and workplace environments. The study has evidenced that it is acceptable to implement web-based resilience programs with similar design features within busy health care settings, indicating a need for similar programs to be carefully evaluated. Mentorship support may also be a key in optimizing resilience. Trial limitations include small sample size and reduced statistical power; a multicenter randomized controlled trial could test effectiveness of the training on a larger scale. Trial Registration: ClinicalTrials.gov NCT05074563; https://clinicaltrials.gov/ct2/show/NCT05074563 International Registered Report Identifier (IRRID): RR2-10.2196/37015 ",
doi="10.2196/43771",
url="https://www.jmir.org/2023/1/e43771",
url="http://www.ncbi.nlm.nih.gov/pubmed/36787181"
}


@Article{info:doi/10.2196/41660,
author="Choi, Woohyeok
and Lee, Uichin",
title="Loss-Framed Adaptive Microcontingency Management for Preventing Prolonged Sedentariness: Development and Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jan",
day="27",
volume="11",
pages="e41660",
keywords="contingency management",
keywords="incentive",
keywords="sedentary behavior",
keywords="sedentariness",
keywords="behavior change",
keywords="health promotion",
keywords="financial incentives",
keywords="health intervention",
keywords="user compliance",
keywords="incentive-based intervention",
keywords="mobile phone",
abstract="Background: A growing body of evidence shows that financial incentives can effectively reinforce individuals' positive behavior change and improve compliance with health intervention programs. A critical factor in the design of incentive-based interventions is to set a proper incentive magnitude. However, it is highly challenging to determine such magnitudes as the effects of incentive magnitude depend on personal attitudes and contexts. Objective: This study aimed to illustrate loss-framed adaptive microcontingency management (L-AMCM) and the lessons learned from a feasibility study. L-AMCM discourages an individual's adverse health behaviors by deducting particular expenses from a regularly assigned budget, where expenses are adaptively estimated based on the individual's previous responses to varying expenses and contexts. Methods: We developed a mobile health intervention app for preventing prolonged sedentary lifestyles. This app delivered a behavioral mission (ie, suggesting taking an active break for a while) with an incentive bid when 50 minutes of uninterrupted sedentary behavior happened. Participants were assigned to either the fixed (ie, deducting the monotonous expense for each mission failure) or adaptive (ie, deducting varying expenses estimated by the L-AMCM for each mission failure) incentive group. The intervention lasted 3 weeks. Results: We recruited 41 participants (n=15, 37\% women; fixed incentive group: n=20, 49\% of participants; adaptive incentive group: n=21, 51\% of participants) whose mean age was 24.0 (SD 3.8; range 19-34) years. Mission success rates did not show statistically significant differences by group (P=.54; fixed incentive group mean 0.66, SD 0.24; adaptive incentive group mean 0.61, SD 0.22). The follow-up analysis of the adaptive incentive group revealed that the influence of incentive magnitudes on mission success was not statistically significant (P=.18; odds ratio 0.98, 95\% CI 0.95-1.01). On the basis of the qualitative interviews, such results were possibly because the participants had sufficient intrinsic motivation and less sensitivity to incentive magnitudes. Conclusions: Although our L-AMCM did not significantly affect users' mission success rate, this study configures a pioneering work toward adaptively estimating incentives by considering user behaviors and contexts through leveraging mobile sensing and machine learning. We hope that this study inspires researchers to develop incentive-based interventions. ",
doi="10.2196/41660",
url="https://mhealth.jmir.org/2023/1/e41660",
url="http://www.ncbi.nlm.nih.gov/pubmed/36705949"
}


@Article{info:doi/10.2196/38597,
author="Luangphituck, Wasana
and Boonyamalik, Plernpit
and Klainin-Yobas, Piyanee",
title="The Effectiveness of Internet-Based Cognitive Behavioral Therapy as a Preventive Intervention in the Workplace to Improve Work Engagement and Psychological Outcomes: Protocol for a Systematic Review and Meta-analysis",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="19",
volume="12",
pages="e38597",
keywords="systematic review",
keywords="internet-based",
keywords="cognitive behavioral therapy",
keywords="work engagement",
keywords="psychological outcomes",
keywords="employees",
keywords="workplace",
keywords="web-based",
keywords="occupational health",
keywords="mental health",
keywords="stress",
keywords="depression",
keywords="anxiety",
keywords="eHealth",
keywords="digital health",
abstract="Background: Mental health has become an increasingly significant issue in the workplace.?Non--health care workers are experiencing increased levels of psychological symptoms in their workplaces, especially during the COVID-19 pandemic, which limited social interactions?and health service access.?These conditions have a negative effect on employees' mental health and may also be associated with work-related outcomes, such as reduced levels of work engagement.?Cognitive behavioral therapy (CBT)?is one of?the most effective methods used for treating workers with mental illness and preventing work-related psychological outcomes. The delivery of internet-based CBT (iCBT) has been established as a result of both technological improvements that have influenced health promotion and prevention components, and limited social contact and health service access. Objective: The purpose of this systematic review is to synthesize the best available evidence concerning the preventive effect of iCBT on employees. Methods: A systematic search will be conducted across 12 electronic databases,?including a hand search for main journals and reference lists. Randomized controlled trials testing the effects of iCBT on psychological outcomes and work engagement among employees will be eligible. Initial keywords will cover the concepts of employees, workers, non--health care personnel, internet-based, web-based, eHealth cognitive behavioral interventions, stress, depression, anxiety, and work engagement, and then a full search strategy will be developed. Following titles, abstracts and the full text will be screened for assessment against the inclusion criteria for the review. Search results will be fully reported and presented per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers will screen and extract data, appraise methodological quality using the Cochrane risk-of-bias assessment tool, and assess overall quality of evidence with the Grading of Recommendations Assessment, Development, and Evaluation approach. A random effects meta-analysis and standardized mean differences using review manager software will be applied to synthesize the effect of iCBT based on similar outcomes. Results: This protocol was registered in the International Prospective Register of Systematic Reviews in March 2022 and is?now an ongoing process. The data will be analyzed in August 2022, and the review process should be completed by December 2022. All included studies will be synthesized and presented to demonstrate the effectiveness of iCBT in decreasing psychological distress and optimizing work engagement outcomes among employees. Conclusions: According to the findings of this study, iCBT therapies will be used to promote mental health concerns such as depressive symptoms, anxiety, psychological distress, stress, insomnia, and resilience among non--health care professionals. In addition, the results will be used to ensure the policy related to reducing psychological distress and optimizing work engagement in the workplace. International Registered Report Identifier (IRRID): PRR1-10.2196/38597 ",
doi="10.2196/38597",
url="https://www.researchprotocols.org/2023/1/e38597",
url="http://www.ncbi.nlm.nih.gov/pubmed/36656635"
}


@Article{info:doi/10.2196/39422,
author="Engdahl, Patrik
and Svedberg, Petra
and Lex{\'e}n, Annika
and Tj{\"o}rnstrand, Carina
and Strid, Catharina
and Bejerholm, Ulrika",
title="Co-design Process of a Digital Return-to-Work Solution for People With Common Mental Disorders: Stakeholder Perception Study",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="18",
volume="7",
pages="e39422",
keywords="co-design",
keywords="mental health",
keywords="mobile health",
keywords="return-to-work",
keywords="supported employment",
abstract="Background: Service users and other stakeholders have had few opportunities to influence the design of their mental health and return-to-work services. Likewise, digital solutions often fail to align with stakeholders' needs and preferences, negatively impacting their utility. mWorks is a co-design initiative to create a digital return-to-work solution for persons with common mental disorders that is acceptable and engaging for those receiving and delivering the intervention. Objective: This study aimed to describe stakeholder perceptions and the involvement of a design process during the prototype development of mWorks. Methods: A co-design approach was used during the iterative development of mWorks. Overall, 86 stakeholders were recruited using a combination of purposeful and convenience sampling. Five stakeholder groups represented service users with experience of sick leave and common mental disorders (n=25), return-to-work professionals (n=19), employers (n=1), digital design and system developers (n=4), and members of the public (n=37). Multiple data sources were gathered using 7 iterations, from March 2018 to November 2020. The rich material was organized and analyzed using content analysis to generate themes and categories that represented this study's findings. Results: The themes revealed the importance of mWorks in empowering service users with a personal digital support solution that engages them back in work. The categories highlighted that mWorks needs to be a self-management tool that enables service users to self-manage as a supplement to traditional return-to-work services. It was also important that content features helped to reshape a positive self-narrative, with a focus on service users' strengths and resources to break the downward spiral of ill health during sick leave. Additional crucial features included helping service users mobilize their own strategies to cope with thoughts and feelings and formulate goals and a plan for their work return. Once testing of the alpha and beta prototypes began, user engagement became the main focus for greater usability. It is critical to facilitate the comprehension and purpose of mWorks, offer clear guidance, and enhance motivational and goal-setting strategies. Conclusions: Stakeholders' experience-based knowledge asserted that mWorks needs to empower service users by providing them with a personal support tool. To enhance return-to-work prospects, users must be engaged in a meaningful manner while focusing on their strengths and resources. ",
doi="10.2196/39422",
url="https://formative.jmir.org/2023/1/e39422",
url="http://www.ncbi.nlm.nih.gov/pubmed/36652285"
}


@Article{info:doi/10.2196/39672,
author="Lin, Elizabeth
and Malhas, Mais
and Bratsalis, Emmanuel
and Thomson, Kendra
and Boateng, Rhonda
and Hargreaves, Fabienne
and Baig, Heba
and Benadict, Benisha Mary
and Busch, Louis",
title="Behavioral Skills Training for Teaching Safety Skills to Mental Health Clinicians: Protocol for a Pragmatic Randomized Control Trial",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="14",
volume="11",
number="12",
pages="e39672",
keywords="workplace safety",
keywords="violence",
keywords="mental health",
keywords="medical education",
keywords="protocol",
keywords="occupational health",
keywords="occupational safety",
keywords="behavioral analysis",
keywords="randomized controlled trial",
keywords="RCT",
keywords="pragmatic",
keywords="training",
keywords="safety",
keywords="self protection",
abstract="Background: Workplace violence is an increasingly significant topic, particularly for staff working in mental health settings. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, considers workplace safety a high priority and consequently has mandated staff safety training. For clinical staff, key components of this training are self-protection and team-control skills, which are a last resort when an individual is at an imminent risk of harm to self or others and other interventions are ineffective (eg, verbal de-escalation). For the past 20 years, CAMH's training-as-usual (TAU) has been based on a 3D approach (description, demonstration, and doing), but without any competency-based assessment. Recent staff reports indicate that the acquisition and retention of these skills may be problematic and that staff are not always confident in their ability to effectively address workplace violence. The current literature lacks studies that evaluate how staff are trained to acquire these physical skills and consequently provides no recommendations or best practice guidelines. To address these gaps described by the staff and in the literature, we have used an evidence-based approach from the field of applied behavior analysis known as behavioral skills training (BST), which requires trainees to actively execute targeted skills through instruction, modeling, practice, and feedback loop. As part of this method, competency checklists of skills are used with direct observation to determine successful mastery. Objective: Our objectives are to evaluate the effectiveness of BST versus TAU in terms of staff confidence; their competence in self-protection and team-control physical skills; their level of mastery (predefined as 80\% competence) in these skills; and their confidence, competency, and mastery at 1 month posttraining. Methods: We are using a pragmatic randomized controlled trial design. New staff registering for their mandatory safety training are randomly assigned to sessions which are, in turn, randomly assigned to either the BST or TAU conditions. Attendees are informed and consented into the study at the beginning of training. Differences between those consenting and those not consenting in terms of role and department are tracked to flag potential biases. Results: This study was internally funded and commenced in January 2021 after receiving ethics approval. As of May 2022, data collection is complete; half of the baseline, posttraining, and 1-month videotapes have been rated, and three-fourths of the interrater reliability checks have been completed. The analysis is expected to begin in late summer 2022 with results submitted for publication by fall 2022. Conclusions: The findings from this study are expected to contribute to both the medical education literature as well as to the field of applied behavioral analysis where randomized controlled trial designs are rare. More practically, the results are also expected to inform the continuing development of our institutional staff safety training program. International Registered Report Identifier (IRRID): DERR1-10.2196/39672 ",
doi="10.2196/39672",
url="https://www.researchprotocols.org/2022/12/e39672",
url="http://www.ncbi.nlm.nih.gov/pubmed/36515979"
}


@Article{info:doi/10.2196/40209,
author="Matava, Clyde
and So, P. Jeannette
and Hossain, Alomgir
and Kelley, Simon",
title="Experiences of Health Care Professionals Working Extra Weekends to Reduce COVID-19--Related Surgical Backlog: Cross-sectional Study",
journal="JMIR Perioper Med",
year="2022",
month="Dec",
day="6",
volume="5",
number="1",
pages="e40209",
keywords="staff",
keywords="wait-list",
keywords="surgery",
keywords="health care delivery",
keywords="patient safety",
keywords="quality improvement",
keywords="patient satisfaction",
keywords="COVID-19",
keywords="practice redesign",
keywords="burnout",
keywords="preoperative",
keywords="pediatric",
keywords="perioperative",
keywords="surgical staff",
keywords="surgeon",
keywords="healthcare",
keywords="health care",
keywords="staff perception",
keywords="workforce",
keywords="stress",
keywords="work",
keywords="occupational health",
keywords="occupational safety",
keywords="perception",
keywords="workload",
keywords="nurse",
keywords="nursing",
keywords="anesthesiologist",
keywords="health care provider",
keywords="health care professional",
keywords="cross-sectional",
keywords="online survey",
abstract="Background: During the quiescent periods of the COVID-19 pandemic in 2020, we implemented a weekend-scheduled pediatric surgery program to reduce COVID-19--related backlogs. Over 100 staff members from anesthesiologists to nurses, surgeons, and administrative and supporting personnel signed up to work extra weekends as part of a novel weekend elective pediatric surgery program to reduce COVID-19--related backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends-Extra Lists (ORRACLE-Xtra). Objective: In this study, we sought to evaluate staff perceptions and their level of satisfaction and experiences with working extra scheduled weekend elective surgical cases at the end of the 3-month pilot phase of ORRACLE-Xtra and identify key factors for participation. Methods: Following the pilot of ORRACLE-Xtra, all perioperative staff who worked at least 1 weekend list were invited to complete an online survey that was developed and tested prior to distribution. The survey collected information on the impact of working weekends on well-being, overall satisfaction, and likelihood of and preferences for working future weekend lists. Logistic regression was used to estimate the association of well-being with satisfaction and willingness to work future weekend lists. Results: A total of 82 out of 118 eligible staff responded to the survey for a response rate of 69\%. Staff worked a median of 2 weekend lists (IQR 1-9). Of 82 staff members, 65 (79\%) were satisfied or very satisfied with working the extra weekend elective lists, with surgeons and surgical trainees reporting the highest levels of satisfaction. Most respondents (72/82, 88\%) would continue working weekend lists. A sense of accomplishment was associated with satisfaction with working on the weekend (odds ratio [OR] 19.97, 95\% CI 1.79-222.63; P=.02) and willingness to participate in future weekend lists (OR 17.74, 95\% CI 1.50-200.70; P=.02). Many (56/82, 68\%) were willing to work weekend lists that included longer, more complex cases, which was associated with a sense of community (OR 0.12, 95\% CI 0.02-0.63; P=.01). Conclusions: Staff participating in the first 3 months of the ORRACLE-Xtra program reported satisfaction with working weekends and a willingness to continue with the program, including doing longer, more complex cases. Institutions planning on implementing COVID-19 surgical backlog work may benefit from gathering key information from their staff. ",
doi="10.2196/40209",
url="https://periop.jmir.org/2022/1/e40209",
url="http://www.ncbi.nlm.nih.gov/pubmed/36423322"
}


@Article{info:doi/10.2196/39238,
author="Thai, Y. Janus
and McCaffrey, Tracy
and Ramadas, Amutha
and Chandrasekara, Dharshani
and Koh, M. Sharon G.
and Choi, Ting Tammie Suet
and Malini, Hema
and Xie, Jue
and Olivier, Patrick
and Md Zain, Zaini Anuar
and Watterson, Jessica",
title="Collective Action for Wellness in the Malaysian Workplace: Protocol for a Feasibility Study",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="5",
volume="11",
number="12",
pages="e39238",
keywords="workplace wellness",
keywords="healthy behaviours",
keywords="chronic diseases",
keywords="digital health",
keywords="Malaysia",
keywords="wellness",
keywords="workplace",
keywords="disease",
keywords="digital wellness",
keywords="digital",
keywords="promote",
keywords="health knowledge",
keywords="diet",
keywords="employee",
keywords="mobile device",
keywords="intervention",
keywords="social",
keywords="social group",
abstract="Background: Chronic diseases and the associated risk factors are preventable with lifestyle changes such as eating a healthier diet and being more physically active. In Malaysia, the prevalence of chronic diseases, including diabetes, hypertension, and heart diseases, has risen. In the present study, we explore the potential of co-designing and implementing a digital wellness intervention to promote socially-driven health knowledge and practices in the workplace in Malaysia, drawing on social cognitive theory, social impact theory, and social influence theory. Objective: This study aims to co-design and assess the feasibility of a socially-driven digital health intervention to promote healthy behavior and prevent chronic diseases in a workplace in Malaysia. Methods: This study involves two phases: (i) identifying the barriers and facilitators to healthy behaviors at work and co-designing the intervention activities with the employees, (ii) implementing and evaluating the intervention's feasibility. Phase 1 will involve qualitative data collection and analysis through semi-structured, in-depth interviews and co-design workshops with the employees, while Phase 2 will consist of a feasibility study employing quantitative measurements of health behaviors through accelerometers and questionnaires. Results: This study was funded in June 2021 and ethics approval for Phase 1 was obtained from the Monash University Human Research Ethics Committee in January 2022. As of August 2022, qualitative interviews with 12 employees have been completed and the data has been transcribed and analyzed. These results will be published in a future paper with results from all Phase 1 activities. Conclusions: The study will help us to better understand the mechanisms through which digital technologies can promote socially-driven health knowledge and behaviors. This research will also result in a scalable wellness intervention that could be further tailored and expanded to other employers and social groups across the region. International Registered Report Identifier (IRRID): PRR1-10.2196/39238 ",
doi="10.2196/39238",
url="https://www.researchprotocols.org/2022/12/e39238/",
url="http://www.ncbi.nlm.nih.gov/pubmed/36469407"
}


@Article{info:doi/10.2196/29130,
author="Chalghaf, Nasr
and Chen, Wen
and Tannoubi, Amayra
and Guelmami, Noomen
and Puce, Luca
and Ben Said, Noureddine
and Ben Khalifa, Maher
and Azaiez, Fairouz
and Bragazzi, Luigi Nicola",
title="Job Disengagement Among Physical Education Teachers: Insights From a Cross-sectional Web-Based Survey With Path Modeling Analysis",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="1",
volume="6",
number="12",
pages="e29130",
keywords="Work Disengagement Scale",
keywords="work",
keywords="job",
keywords="job satisfaction",
keywords="family--work conflict",
keywords="perceived stress",
keywords="physical education",
keywords="PLS-SEM",
keywords="SmartPLS",
keywords="teacher",
keywords="engagement",
keywords="Arab",
keywords="stress",
keywords="primary school",
keywords="secondary school",
keywords="development",
keywords="measurement",
keywords="scale",
keywords="tool",
keywords="fitness",
keywords="educator",
keywords="school",
keywords="satisfaction",
keywords="digital tool",
keywords="mental health",
keywords="family",
keywords="cross-sectional",
keywords="survey",
keywords="modelling",
keywords="psychology",
abstract="Background: Physical education teachers often experience stress and job disengagement. Objective: This study's aims were as follows: (1) to adapt in the Arabic language and test the reliability and the validity of the work--family conflict (WFC) and family--work conflict (FWC) scales, (2) to develop and assess the psychometric properties of work disengagement among physical education teachers, and (3) to evaluate an explanatory model by presenting the mediating role of perceived stress as a major influencing factor in work disengagement and job satisfaction. Methods: A total of 303 primary and secondary school physical education teachers, comprising 165 (54.5\%) men and 138 (45.5\%) women participated voluntarily in our study. The measuring instruments are the Work Disengagement Scale, the Perceived Stress Scale, the WFC scale, the FWC scale, and the 9-item Teacher of Physical Education Job Satisfaction Inventory. Results: The Arabic language versions of the WFC and FWC scales had reasonably adequate psychometric properties, which were justified by confirmatory factor analyses and by the measurement of reliability, convergent, and discriminant validity through the measurement model using SmartPLS software. Similarly, the structural model established with SmartPLS confirmed strong links of the concepts of FWC, WFC, the job satisfaction questionnaire, and perceived stress with work disengagement among teachers of physical education. Conclusions: There is a growing interest in helping teachers cope with the daily pressures of work and family. A positive organizational context is a context with clear values regarding work priorities, which constitutes the basis of a feeling of shared responsibility and professional support. Good conditions can act as protective factors reducing work stress and positively influencing personal well-being, work attitudes, work commitment, and professional efficiency. Additional research on teachers is needed to examine the relationship between perceived work stress and the role of families, along with the extent to which this association can have a significant impact on teachers' commitment to work. ",
doi="10.2196/29130",
url="https://formative.jmir.org/2022/12/e29130",
url="http://www.ncbi.nlm.nih.gov/pubmed/36084318"
}


@Article{info:doi/10.2196/40339,
author="Watanabe, Kazuhiro
and Tsutsumi, Akizumi",
title="The Passive Monitoring of Depression and Anxiety Among Workers Using Digital Biomarkers Based on Their Physical Activity and Working Conditions: 2-Week Longitudinal Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="30",
volume="6",
number="11",
pages="e40339",
keywords="digital biomarkers",
keywords="mobile health",
keywords="mental health",
keywords="psychological distress",
keywords="depression",
keywords="anxiety",
keywords="physical activity",
abstract="Background: Digital data on physical activity are useful for self-monitoring and preventing depression and anxiety. Although previous studies have reported machine or deep learning models that use physical activity for passive monitoring of depression and anxiety, there are no models for workers. The working population has different physical activity patterns from other populations, which is based on commuting, holiday patterns, physical demands, occupations, and industries. These working conditions are useful in optimizing the model used in predicting depression and anxiety. Further, recurrent neural networks increase predictive accuracy by using previous inputs on physical activity, depression, and anxiety. Objective: This study evaluated the performance of a deep learning model optimized for predicting depression and anxiety in workers. Psychological distress was considered a depression and anxiety indicator. Methods: A 2-week longitudinal study was conducted with workers in urban areas in Japan. Absent workers were excluded. In a daily survey, psychological distress was measured using a self-reported questionnaire. As features, activity time by intensity was determined using the Google Fit application. Additionally, we measured age, gender, occupations, employment status, work shift types, working hours, and whether the response date was a working or nonworking day. A deep learning model, using long short-term memory, was developed and validated to predict psychological distress the next day, using features of the previous day. Further, a 5-fold cross-validation method was used to evaluate the performance of the aforementioned model. As the primary indicator of performance, classification accuracy for the severity of the psychological distress (light, subthreshold, and severe) was considered. Results: A total of 1661 days of supervised data were obtained from 236 workers, who were aged between 20 and 69 years. The overall classification accuracy for psychological distress was 76.3\% (SD 0.04\%). The classification accuracy for severe-, subthreshold-, and light-level psychological distress was 51.1\% (SD 0.05\%), 60.6\% (SD 0.05\%), and 81.6\% (SD 0.04\%), respectively. The model predicted a light-level psychological distress the next day after the participants had been involved in 3 peaks of activity (in the morning, noon, and evening) on the previous day. Lower activity levels were predicted as subthreshold- and severe-level psychological distress. Different predictive results were observed on the basis of occupations and whether the previous day was a working or nonworking day. Conclusions: The developed deep learning model showed a similar performance as in previous studies and, in particular, high accuracy for light-level psychological distress. Working conditions and long short-term memory were useful in maintaining the model performance for monitoring depression and anxiety, using digitally recorded physical activity in workers. The developed model can be implemented in mobile apps and may further be practically used by workers to self-monitor and maintain their mental health state. ",
doi="10.2196/40339",
url="https://formative.jmir.org/2022/11/e40339",
url="http://www.ncbi.nlm.nih.gov/pubmed/36449342"
}


@Article{info:doi/10.2196/38562,
author="Tump, Danielle
and Narayan, Nitin
and Verbiest, Vera
and Hermsen, Sander
and Goris, Annelies
and Chiu, Chui-De
and Van Stiphout, Ruud",
title="Stressors and Destressors in Working From Home Based on Context and Physiology From Self-Reports and Smartwatch Measurements: International Observational Study Trial",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="10",
volume="6",
number="11",
pages="e38562",
keywords="stress",
keywords="telework",
keywords="wearables",
keywords="COVID-19",
keywords="pandemic",
keywords="remote working",
keywords="employees",
keywords="stressors",
keywords="destressors",
keywords="remote work",
keywords="mental health",
keywords="psychological health",
keywords="smartphone",
keywords="digital questionnaire",
keywords="stress management",
keywords="occupational health",
keywords="stress detection",
keywords="prediction model",
abstract="Background: The COVID-19 pandemic has greatly boosted working from home as a way of working, which is likely to continue for most companies in the future, either in fully remote or in hybrid form. To manage stress levels in employees working from home, insights into the stressors and destressors in a home office first need to be studied. Objective: We present an international remote study with employees working from home by making use of state-of-the-art technology (ie, smartwatches and questionnaires through smartphones) first to determine stressors and destressors in people working from home and second to identify smartwatch measurements that could represent these stressors and destressors. Methods: Employees working from home from 3 regions of the world (the United States, the United Kingdom, and Hong Kong) were asked to wear a smartwatch continuously for 7 days and fill in 5 questionnaires each day and 2 additional questionnaires before and after the measurement week. The entire study was conducted remotely. Univariate statistical analyses comparing variable distributions between low and high stress levels were followed by multivariate analysis using logistic regression, considering multicollinearity by using variance inflation factor (VIF) filtering. Results: A total of 202 people participated, with 198 (98\%) participants finishing the experiment. Stressors found were other people and daily life getting in the way of work (P=.05), job intensity (P=.01), a history of burnout (P=.03), anxiety toward the pandemic (P=.04), and environmental noise (P=.01). Destressors found were access to sunlight (P=.02) and fresh air (P<.001) during the workday and going outdoors (P<.001), taking breaks (P<.001), exercising (P<.001), and having social interactions (P<.001). The smartwatch measurements positively related to stress were the number of active intensity periods (P<.001), the number of highly active intensity periods (P=.04), steps (P<.001), and the SD in the heart rate (HR; P<.001). In a multivariate setting, only a history of burnout (P<.001) and family and daily life getting in the way of work (P<.001) were positively associated with stress, while self-reports of social activities (P<.001) and going outdoors (P=.03) were negatively associated with stress. Stress prediction models based on questionnaire data had a similar performance (F1=0.51) compared to models based on automatic measurable data alone (F1=0.47). Conclusions: The results show that there are stressors and destressors when working from home that should be considered when managing stress in employees. Some of these stressors and destressors are (in)directly measurable with unobtrusive sensors, and prediction models based on these data show promising results for the future of automatic stress detection and management. Trial Registration: Netherlands Trial Register NL9378; https://trialsearch.who.int/Trial2.aspx?TrialID=NL9378 ",
doi="10.2196/38562",
url="https://formative.jmir.org/2022/11/e38562",
url="http://www.ncbi.nlm.nih.gov/pubmed/36265030"
}


@Article{info:doi/10.2196/33638,
author="Bulzacchelli, T. Maria
and Bellantoni, M. Jenna
and McCue, Leigh
and Dzugan, Jerry",
title="The Receptivity to Safety-Related Mobile Apps Among Commercial Fishing Captains: Descriptive Exploratory Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="8",
volume="6",
number="11",
pages="e33638",
keywords="mobile app",
keywords="mobile device",
keywords="mobile phone",
keywords="smartphone",
keywords="safety",
keywords="workplace safety",
keywords="occupational safety",
keywords="mobile health",
keywords="mHealth",
keywords="commercial fishing",
keywords="cross-sectional study",
abstract="Background: Mobile apps addressing a variety of workplace safety issues have proliferated over the last decade as mobile technology has advanced and smartphone ownership has increased. Workplace safety interventions are often designed for a specific work site. However, some of the most dangerous jobs are ones in which workers frequently change field locations, such as commercial fishing. Mobile apps may be particularly suitable for delivering safety interventions to these workers. Objective: We sought to gauge the potential for using mobile apps to deliver safety interventions to commercial fishing workers. The purpose of this paper is to describe how fishermen use their mobile devices during fishing operations and identify any mobile apps they already use for safety. Methods: Participants comprised commercial fishing captains who already owned an iOS or Android smartphone or tablet. They completed a questionnaire that asked about their current mobile device use and their use of safety-related mobile apps, in addition to questions about their fishing operations. We performed descriptive analyses of the data. Results: A total of 61 participants completed the questionnaire. The most common types of mobile devices participants reported owning were iPhones (n=36, 59\%) and Android phones (n=24, 39\%). Most participants (n=53, 87\%) reported using their mobile device for both work and personal purposes, including while out at sea (n=52, 85\%). Over half of the participants reported that they had either safety-related apps (n=17, 28\%) or apps that help them with their work (n=35, 57\%). The types of apps most frequently mentioned were apps for weather, wind, tides, and navigation. Conclusions: The results of this study indicate that some commercial fishing captains who own a mobile device are receptive to using safety-related apps for work. Apps that help avoid hazards by monitoring environmental conditions and apps optimized for use on smartphones may be most likely to be adopted and used. Overall, these results suggest that mobile apps are a promising avenue for improving safety among workers in commercial fishing and similar occupations. ",
doi="10.2196/33638",
url="https://formative.jmir.org/2022/11/e33638",
url="http://www.ncbi.nlm.nih.gov/pubmed/36346649"
}


@Article{info:doi/10.2196/42338,
author="Soares, Pontes Juliana
and Lopes, Horacio Rayssa
and Mendon{\c{c}}a, Souza Paula Beatriz de
and Silva, Vieira C{\'i}cera Renata Diniz
and Rodrigues, Martins Cl{\'a}udia Cristiane Filgueira
and Castro, de Janete Lima",
title="Use of the Maslach Burnout Inventory Among Public Health Care Professionals: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2022",
month="Nov",
day="1",
volume="11",
number="11",
pages="e42338",
keywords="health care personnel",
keywords="health care workers",
keywords="public health services",
keywords="Maslach burnout inventory",
keywords="burnout, health care professional",
keywords="workplace stress",
keywords="mental health",
keywords="occupational health",
keywords="psychological well-being",
keywords="policymaker",
abstract="Background: Burnout syndrome is a chronic response to stressors in the workplace. It is characterized by emotional exhaustion and physical and mental burnout and may lead to high employee turnover, work absenteeism, and increased occupational accidents. Most studies use the Maslach Burnout Inventory (MBI) to identify burnout and implement preventive actions and treatments. Objective: This study presents a scoping review protocol to identify and map studies that used MBI to assess burnout syndrome in health care professionals working in public health services. Methods: This scoping review protocol follows the Joanna Briggs Institute reviewers' manual, and this protocol consists of 6 stages: identifying the research question, identifying relevant studies, study selection, data extraction and coding, analysis and interpretation of results, and consultation with stakeholders. We will conduct searches in Embase, LILACS, PubMed/MEDLINE, PsycINFO, Scopus, Web of Science databases, and gray literature. The main research question is as follows: how is MBI used to identify burnout syndrome in health care professionals working in public health services? Inclusion criteria will comprise qualitative and quantitative studies using MBI to identify burnout syndrome in health care professionals working in public health services and no restrictions in language and publication dates. Data will be extracted using a spreadsheet adapted from the Joanna Briggs Institute model. Quantitative and qualitative data will be analyzed using descriptive statistics and thematic analysis, respectively. The consultation with stakeholders will be essential for increasing the knowledge about MBI, identifying new evidence, and developing future strategies to guide public policies preventing burnout syndrome in health care professionals working in public services. Results: This protocol will guide a scoping review to identify and map studies that used MBI to identify burnout syndrome in health care professionals working in public health services. The results of this review may be useful to public health care professionals, managers, policymakers, and the general population because these findings will help understand the validated, translated, and adapted versions of MBI and domains, number of items, Likert scales, and cutoff points or the latent profile analysis most used in the literature. Furthermore, possible research gaps may be identified to guide future studies. All information regarding the stages of the scoping review favor its transparency and allow it to be methodologically replicated according to the principles of open science, thereby reducing the risk of bias and data duplication. Conclusions: This study may reveal the multiplicity of scales described in the literature and the different forms of assessing burnout syndrome in health care professionals. This study may help to standardize the assessment of burnout syndrome in health care professionals working in public health services and contribute to the discussion and knowledge dissemination about burnout syndrome and mental health in this population. International Registered Report Identifier (IRRID): DERR1-10.2196/42338 ",
doi="10.2196/42338",
url="https://www.researchprotocols.org/2022/11/e42338",
url="http://www.ncbi.nlm.nih.gov/pubmed/36318252"
}


@Article{info:doi/10.2196/40488,
author="Nixon, Patricia
and Ebert, Daniel David
and Bo{\ss}, Leif
and Angerer, Peter
and Dragano, Nico
and Lehr, Dirk",
title="The Efficacy of a Web-Based Stress Management Intervention for Employees Experiencing Adverse Working Conditions and Occupational Self-efficacy as a Mediator: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="20",
volume="24",
number="10",
pages="e40488",
keywords="occupational eMental health",
keywords="stress",
keywords="occupational self-efficacy",
keywords="effort-reward imbalance",
keywords="randomized controlled trial",
abstract="Background: Work stress is highly prevalent and puts employees at risk for adverse health consequences. Web-based stress management interventions (SMIs) promoting occupational self-efficacy might be a feasible approach to aid employees to alleviate this burden and to enable them to improve an unbalanced situation between efforts and rewards at work. Objective: The first aim of this randomized controlled trial was to investigate the efficacy of a web-based SMI for employees perceiving elevated stress levels and an effort-reward imbalance in comparison to a waitlist control (WLC) group. Second, we investigated whether the efficacy of an SMI could be explained by an increase in occupational self-efficacy and whether this personal resource enables employees to change adverse working conditions. Methods: A total of 262 employees reporting effort-reward imbalance scores over 0.715 and elevated stress levels (10-item Perceived Stress Scale [PSS-10] score ?22) were randomly assigned to either the intervention group (IG; SMI) or the WLC group. The primary outcome was perceived stress measured using the PSS-10. The secondary outcomes included mental and work-related health measures. Four different mediation analyses were conducted with occupational self-efficacy, efforts, and rewards as mediators. After eligibility screening, data were collected web based at baseline (T1), 7 weeks (T2) and 6 months (T3). Results: Study participation was completed by 80\% (105/130, 80.8\%) in the IG and 90\% (119/132, 90.2\%) in the WLC group. Analyses of covariance revealed that stress reduction was significantly higher for the SMI group compared with the WLC group at T2 (d=0.87, 95\% CI 0.61-1.12, P<.001) and T3 (d=0.65, 95\% CI 0.41-0.90, P<.001). Mediation analyses indicated that occupational self-efficacy mediated the beneficial effect of the SMI on stress directly. Furthermore, the analyses revealed a significant indirect effect of occupational self-efficacy via rewards (b=0.18, t259=4.52, P<.001), but not via efforts (b=0.01, t259=0.27, P>.05) while efforts still had a negative impact on stress (b=0.46, t257=2.32, P<.05). Conclusions: The SMI was effective in reducing stress and improving occupational self-efficacy in employees despite them experiencing an effort-reward imbalance at work. Results from mediation analyses suggest that fostering personal resources such as occupational self-efficacy contributes to the efficacy of the SMI and enables employees to achieve positive changes regarding the rewarding aspects of the workplace. However, the SMI seemed to neither directly nor indirectly impact efforts, suggesting that person-focused interventions might not be sufficient and need to be complemented by organizational-focused interventions to comprehensively improve mental health in employees facing adverse working conditions. Trial Registration: German Clinical Trials Register DRKS00005990; https://tinyurl.com/23fmzfu3 ",
doi="10.2196/40488",
url="https://www.jmir.org/2022/10/e40488",
url="http://www.ncbi.nlm.nih.gov/pubmed/36264607"
}


@Article{info:doi/10.2196/40500,
author="Espel-Huynh, Hallie
and Baldwin, Matthew
and Puzia, Megan
and Huberty, Jennifer",
title="The Indirect Effects of a Mindfulness Mobile App on Productivity Through Changes in Sleep Among Retail Employees: Secondary Analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Sep",
day="28",
volume="10",
number="9",
pages="e40500",
keywords="mindfulness",
keywords="mobile apps",
keywords="workforce",
keywords="workplace",
keywords="sleep",
keywords="presenteeism",
keywords="mobile phone",
abstract="Background: Chronic sleep disturbance is prevalent among United States employees and associated with costly productivity impairment. Mindfulness interventions improve sleep (ie, insomnia and daytime sleepiness) and productivity outcomes, and mobile apps provide scalable means of intervention delivery. However, few studies have examined the effects of mindfulness mobile apps on employees, and no research to date has tested the role of sleep improvement as a potential mechanism of action for productivity outcomes. Objective: This study examined the effects of Calm, a consumer-based mindfulness app, and sleep coaching, on productivity impairment among retail employees through the indirect effects of changes in insomnia and daytime sleepiness. Methods: This study was a secondary analysis of data from a randomized controlled trial (N=1029) comparing the use of Calm (n=585, 56.9\%) to a waitlist control (n=444, 43.2\%) for 8 weeks among employees of a large retail employer in the United States. A subset of individuals with elevated insomnia symptoms also had access to brief sleep coaching with Calm (n=101, 9.8\%). Insomnia symptom severity, daytime sleepiness, and productivity impairment (ie, absenteeism, presenteeism, overall productivity impairment, and non--work activity impairment) were assessed at baseline and weeks 2, 4, 6, and 8. Indirect effects were evaluated with latent growth curve modeling to test whether the Calm intervention (Calm group vs waitlist control) was effective in reducing work productivity impairment through changes in sleep disturbance. Results: No significant main effects of Calm intervention on productivity impairment were detected for any outcome at $\alpha$ level of .05, with the exception of non--work activity impairment models, in which Calm intervention reduced non--work activity impairment over time (P=.01 and P=.02 for insomnia and sleepiness models, respectively). Significant indirect effects of insomnia were detected for presenteeism (P=.002), overall work productivity (P=.01), and non--work activity impairment (P=.002); Calm intervention produced significantly greater reductions in insomnia symptoms (relative to waitlist control), and decreases in insomnia were associated with decreases in work productivity impairment. There was no significant indirect effect of change in insomnia on changes in absenteeism (P=.20). Furthermore, we detected no significant indirect effects of daytime sleepiness on productivity impairment. Conclusions: We found that Calm (plus sleep coaching for a small subset of individuals) had beneficial effects on employee sleep, and these benefits on sleep were related to indirect effects on productivity impairment (ie, presenteeism, overall work productivity impairment, and non--work activity impairment). There were no overall main effects of Calm intervention on productivity impairment; however, insomnia appears to be a mechanism associated with benefits for employee productivity. This is one of the first studies to suggest that sleep benefits of a mindfulness mobile app may also indirectly relate to benefits for workplace productivity. Trial Registration: ClinicalTrials.gov NCT05120310; https://clinicaltrials.gov/ct2/show/NCT05120310 ",
doi="10.2196/40500",
url="https://mhealth.jmir.org/2022/9/e40500",
url="http://www.ncbi.nlm.nih.gov/pubmed/36169994"
}


@Article{info:doi/10.2196/39883,
author="Brehon, Katelyn
and Niemel{\"a}inen, Riikka
and Hall, Mark
and Bostick, P. Geoff
and Brown, A. Cary
and Wieler, Marguerite
and Gross, P. Douglas",
title="Return-to-Work Following Occupational Rehabilitation for Long COVID: Descriptive Cohort Study",
journal="JMIR Rehabil Assist Technol",
year="2022",
month="Sep",
day="14",
volume="9",
number="3",
pages="e39883",
keywords="compensation and redress",
keywords="postacute COVID-19 syndrome",
keywords="long COVID",
keywords="COVID-19",
keywords="rehabilitation",
keywords="return-to-work",
keywords="health outcome",
keywords="occupational health",
keywords="patient-reported outcome",
keywords="anxiety disorder",
abstract="Background: Emerging evidence suggests that worldwide, between 30\% and 50\% of those who are infected with COVID-19 experience long COVID (LC) symptoms. These symptoms create challenges with return-to-work (RTW) in a high proportion of individuals with LC. To tailor rehabilitation programs to LC sequelae and help improve RTW outcomes, more research on LC rehabilitation program outcomes is needed. Objective: This study describes the characteristics and outcomes of workers who participated in an LC occupational rehabilitation program. Methods: A cohort study was conducted. Descriptive variables included demographic and occupational factors as well as patient-reported outcome measures (PROMs, ie, the Fatigue Severity Scale [FSS], the Post-COVID Functional Scale [PCFS], the 36-item Short Form Health Survey [SF-36], the Pain Disability Index [PDI], the pain Visual Analogue Scale [VAS], the 9-item Patient Health Questionnaire [PHQ-9], the 7-item Generalized Anxiety Disorder Questionnaire [GAD-7], and the Diagnostic and Statistical Manual for Mental Disorders Fifth Edition [DSM-5] posttraumatic stress disorder [PTSD] checklist [PCL-5]). The main outcome variable was the RTW status at discharge. Descriptive statistics were calculated. Logistic regression examined predictors of RTW. Results: The sample consisted of 81 workers. Most workers were female (n=52, 64\%) and from health-related occupations (n=43, 53\%). Only 43 (53\%) individuals returned to work at program discharge, with 40 (93\%) of these returning to modified duties. Although there were statistically significant improvements on the pain VAS (mean 11.1, SD 25.6, t31=2.5, P=.02), the PDI (mean 9.4, SD 12.5, t32=4.3, P<.001), the FSS (mean 3.9, SD 8.7, t38=2.8, P=.01), the SF-36 PCS (mean 4.8, SD 8.7, t38=--3.5, P=.001), the PHQ-9 (mean 3.7, SD 4.0, t31=5.2, P<.001), and the GAD-7 (mean 1.8, SD 4.4, t22=1.8, P=.03), there were no significant improvements in the PCFS, the overall mental component score (MCS) of the SF-36, or on the PCL-5. The availability of modified duties (odds ratio [OR] 3.38, 95\% CI 1.26-9.10) and shorter time between infection and admission for rehabilitation (OR 0.99, 95\% CI 0.99-1.00) predicted RTW even when controlling for age and gender. Conclusions: Workers undergoing LC rehabilitation reported significant but modest improvements on a variety of PROMs, but only 43 (53\%) returned to work. Outcomes would likely improve with increased availability of modified duties and timelier rehabilitation. Additional research is needed, including larger observational cohorts as well as randomized controlled trials to evaluate the effectiveness of LC rehabilitation. ",
doi="10.2196/39883",
url="https://rehab.jmir.org/2022/3/e39883",
url="http://www.ncbi.nlm.nih.gov/pubmed/36094442"
}


@Article{info:doi/10.2196/31744,
author="Taylor, Heather
and Cavanagh, Kate
and Field, P. Andy
and Strauss, Clara",
title="Health Care Workers' Need for Headspace: Findings From a Multisite Definitive Randomized Controlled Trial of an Unguided Digital Mindfulness-Based Self-help App to Reduce Healthcare Worker Stress",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Aug",
day="25",
volume="10",
number="8",
pages="e31744",
keywords="self-help",
keywords="mindfulness",
keywords="randomized control trial",
keywords="health care worker",
keywords="National Health Service",
keywords="NHS",
keywords="doctors",
keywords="nurses",
keywords="stress",
keywords="mental health",
keywords="burnout",
keywords="mobile phone",
abstract="Background: Health care workers experience high stress. Accessible, affordable, and effective approaches to reducing stress are lacking. In-person mindfulness-based interventions can reduce health care worker stress but are not widely available or accessible to busy health care workers. Unguided, digital, mindfulness-based self-help (MBSH) interventions show promise and can be flexibly engaged with. However, their effectiveness in reducing health care worker stress has not yet been explored in a definitive trial. Objective: This study aimed to investigate the effectiveness of an unguided digital MBSH app (Headspace) in reducing health care worker stress. Methods: This was a definitive superiority randomized controlled trial with 2182 National Health Service staff in England recruited on the web and allocated in a 1:1 ratio to fully automated Headspace (n=1095, 50.18\%) or active control (Moodzone; n=1087, 49.82\%) for 4.5 months. Outcomes were subscales of the Depression, Anxiety, and Stress (primary outcome) Scale short form; Short Warwick Edinburgh Mental Well-being Scale; Maslach Burnout Inventory; 15-item Five-Facet Mindfulness Questionnaire minus Observe items; Self-Compassion Scale--Short Form; Compassionate Love Scale; Penn State Worry Questionnaire; Brooding subscale of the Ruminative Response Scale; and sickness absence. Results: Intention-to-treat analyses found that Headspace led to greater reductions in stress over time than Moodzone (b=--0.31, 95\% CI --0.47 to --0.14; P<.001), with small effects. Small effects of Headspace versus Moodzone were found for depression (b=--0.24, 95\% CI --0.40 to --0.08; P=.003), anxiety (b=--0.19, 95\% CI --0.32 to --0.06; P=.004), well-being (b=0.14, 95\% CI 0.05-0.23; P=.002), mindfulness (b=0.22, 95\% CI 0.09-0.34; P=.001), self-compassion (b=0.48, 95\% CI 0.33-0.64; P<.001), compassion for others (b=0.02, 95\% CI 0.00-0.04; P=.04), and worry (b=--0.30, 95\% CI --0.51 to --0.09; P=.005) but not for burnout (b=--0.19, --0.04, and 0.13, all 95\% CIs >0; P=.65, .67, and .35), ruminative brooding (b=--0.06, 95\% CI --0.12 to 0.00; P=.06), or sickness absence ($\gamma$=0.09, 95\% CI --0.18 to 0.34). Per-protocol effects of Headspace (454/1095, 41.46\%) versus Moodzone (283/1087, 26.03\%) over time were found for stress, self-compassion, and compassion for others but not for the other outcomes. Engagement (practice days per week) and improvements in self-compassion during the initial 1.5-month intervention period mediated pre- to postintervention improvements in stress. Improvements in mindfulness, rumination, and worry did not mediate pre- to postintervention improvements in stress. No serious adverse events were reported. Conclusions: An unguided digital MBSH intervention (Headspace) can reduce health care workers' stress. Effect sizes were small but could have population-level benefits. Unguided digital MBSH interventions can be part of the solution to reducing health care worker stress alongside potentially costlier but potentially more effective in-person mindfulness-based interventions, nonmindfulness courses, and organizational-level interventions. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN15424185; https://tinyurl.com/rv9en5kc ",
doi="10.2196/31744",
url="https://mhealth.jmir.org/2022/8/e31744",
url="http://www.ncbi.nlm.nih.gov/pubmed/36006668"
}


@Article{info:doi/10.2196/39129,
author="Michelsen, Clive
and Kjellgren, Anette",
title="The Effectiveness of Web-Based Psychotherapy to Treat and Prevent Burnout: Controlled Trial",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="11",
volume="6",
number="8",
pages="e39129",
keywords="risk for burnout",
keywords="effectivity of web-based therapy",
keywords="Proactive Occupational Health",
keywords="presenteeism",
keywords="work-related stress",
abstract="Background: Burnout is a hidden productivity killer in organizations. Finding a solution to efficiently measure and proactively prevent or rehabilitate employees with burnout is a challenge. To meet this unabated demand, companies and caregivers can focus on proactive measures to prevent ``Burnout as an Occupational Phenomenon.'' Objective: We aimed to address effectiveness, reliability, and validity of the empowerment for participation (EFP) batch of assessments to measure burnout risk in relation to the efficacy of web-based interventions using cognitive behavioral therapy (CBT) and floating to improve mental health and well-being. We introduced three risk assessments: risk for burnout, risk of anxiety, and risk for depression. Methods: We used an interventional, empirical, and parallel design using raw EFP psychometric data to measure the effectiveness of web-based therapy to reduce the risk of burnout between a control group and web-based therapy group. A total of 50 participants were selected. The rehabilitation and control groups consisted of 25 normally distributed employees each. The rehabilitation group received therapy, whereas the control group had not yet received any form of therapy. IBM SPSS was used to analyze the data collected, and a repeated measures ANOVA, an analysis of covariance, a discriminant analysis, and a construct validity analysis were used to test for reliability and validity. The group was selected from a list of employees within the My-E-Health ecosystem who showed a moderate or high risk for burnout. All assessments and mixed-method CBT were web-based, and floating was conducted at designated locations. The complete EFP assessment was integrated into a digital ecosystem designed for this purpose and therapy, offering a secure and encrypted ecosystem. Results: There was a statistically significant difference between pre- and postassessment scores for burnout. The reliability of the burnout measure was good (Cronbach $\alpha$=.858; mean 1.826, SD 3.008; Cohen d=0.607; P<.001) with a high validity of 0.9420. A paired samples 2-tailed test showed a good t score of 4.292 and P<.001, with a good effect size, Cohen d=0.607. Web-based therapy reduced the risk for burnout in participants compared with the control group. Tests of between-subject effects show F=16.964, a significant difference between the control group and the web-based therapy group: P<.001, with movement between the group variables of 0.261 or 26.1\% for the dependent variable. Conclusions: This study suggests good reliability and validity of using web-based interventional mixed methods CBT to reduce the risk of burnout. The EFP batch of web-based assessments could reliably identify morbidity risk levels and successfully measure clinical interventions and rehabilitation with consistently reliable results to serve as both a diagnostic and therapeutic tool worthy of major research in the future. Trial Registration: ClinicalTrials.gov NCT05343208; https://clinicaltrials.gov/ct2/show/NCT05343208 ",
doi="10.2196/39129",
url="https://formative.jmir.org/2022/8/e39129",
url="http://www.ncbi.nlm.nih.gov/pubmed/35802001"
}


@Article{info:doi/10.2196/39789,
author="Lei, Zhengdong
and Martignetti, Lisa
and Ridgway, Chelsea
and Peacock, Simon
and Sakata, T. Jon
and Li-Jessen, K. Nicole Y.",
title="Wearable Neck Surface Accelerometers for Occupational Vocal Health Monitoring: Instrument and Analysis Validation Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="5",
volume="6",
number="8",
pages="e39789",
keywords="mechano-acoustic sensing",
keywords="voice monitoring",
keywords="wearable device",
keywords="neck surface accelerometer",
abstract="Background: Neck surface accelerometer (NSA) wearable devices have been developed for voice and upper airway health monitoring. As opposed to acoustic sounds, NSA senses mechanical vibrations propagated from the vocal tract to neck skin, which are indicative of a person's voice and airway conditions. NSA signals do not carry identifiable speech information and a speaker's privacy is thus protected, which is important and necessary for continuous wearable monitoring. Our device was already tested for its durable endurance and signal processing algorithms in controlled laboratory conditions. Objective: This study aims to further evaluate both instrument and analysis validity in a group of occupational vocal users, namely, voice actors, who use their voices extensively at work in an ecologically valid setting. Methods: A total of 16 professional voice actors (age range 21-50 years; 11 females and 5 males) participated in this study. All participants were mounted with an NSA on their sternal notches during the voice acting and voice assessment sessions. The voice acting session was 4-hour long, directed by a voice director in a professional sound studio. Voice assessment sessions were conducted before, during, and 48 hours after the acting session. The assessment included phonation tasks of passage reading, sustained vowels, maximum vowel phonation, and pitch glides. Clinical acoustic metrics (eg, fundamental frequency, cepstral measures) and a vocal dose measure (ie, accumulated distance dose from acting) were computed from NSA signals. A commonly used online questionnaire (Self-Administered Voice Rating questionnaire) was also implemented to track participants' perception of vocal fatigue. Results: The NSA wearables stayed in place for all participants despite active body movements during the acting. The ensued body noise did not interfere with the NSA signal quality. All planned acoustic metrics were successfully derived from NSA signals and their numerical values were comparable with literature data. For a 4-hour long voice acting, the averaged distance dose was about 8354 m with no gender differences. Participants perceived vocal fatigue as early as 2 hours after the start of voice acting, with recovery 24-48 hours after the acting session. Among all acoustic metrics across phonation tasks, cepstral peak prominence and spectral tilt from the passage reading most closely mirrored trends in perceived fatigue. Conclusions: The ecological validity of an in-house NSA wearable was vetted in a workplace setting. One key application of this wearable is to prompt occupational voice users when their vocal safety limits are reached for duly protection. Signal processing algorithms can thus be further developed for near real-time estimation of clinically relevant metrics, such as accumulated distance dose, cepstral peak prominence, and spectral tilt. This functionality will enable continuous self-awareness of vocal behavior and protection of vocal safety in occupational voice users. ",
doi="10.2196/39789",
url="https://formative.jmir.org/2022/8/e39789",
url="http://www.ncbi.nlm.nih.gov/pubmed/35930317"
}


@Article{info:doi/10.2196/33754,
author="Martinez, J. Gonzalo
and Grover, Ted
and Mattingly, M. Stephen
and Mark, Gloria
and D'Mello, Sidney
and Aledavood, Talayeh
and Akbar, Fatema
and Robles-Granda, Pablo
and Striegel, Aaron",
title="Alignment Between Heart Rate Variability From Fitness Trackers and Perceived Stress: Perspectives From a Large-Scale In Situ Longitudinal Study of Information Workers",
journal="JMIR Hum Factors",
year="2022",
month="Aug",
day="4",
volume="9",
number="3",
pages="e33754",
keywords="stress measurement",
keywords="heart rate variability",
keywords="HRV",
keywords="perceived stress",
keywords="ecological momentary assessment",
keywords="EMA",
keywords="wearables",
keywords="fitness tracker",
abstract="Background: Stress can have adverse effects on health and well-being. Informed by laboratory findings that heart rate variability (HRV) decreases in response to an induced stress response, recent efforts to monitor perceived stress in the wild have focused on HRV measured using wearable devices. However, it is not clear that the well-established association between perceived stress and HRV replicates in naturalistic settings without explicit stress inductions and research-grade sensors. Objective: This study aims to quantify the strength of the associations between HRV and perceived daily stress using wearable devices in real-world settings. Methods: In the main study, 657 participants wore a fitness tracker and completed 14,695 ecological momentary assessments (EMAs) assessing perceived stress, anxiety, positive affect, and negative affect across 8 weeks. In the follow-up study, approximately a year later, 49.8\% (327/657) of the same participants wore the same fitness tracker and completed 1373 EMAs assessing perceived stress at the most stressful time of the day over a 1-week period. We used mixed-effects generalized linear models to predict EMA responses from HRV features calculated over varying time windows from 5 minutes to 24 hours. Results: Across all time windows, the models explained an average of 1\% (SD 0.5\%; marginal R2) of the variance. Models using HRV features computed from an 8 AM to 6 PM time window (namely work hours) outperformed other time windows using HRV features calculated closer to the survey response time but still explained a small amount (2.2\%) of the variance. HRV features that were associated with perceived stress were the low frequency to high frequency ratio, very low frequency power, triangular index, and SD of the averages of normal-to-normal intervals. In addition, we found that although HRV was also predictive of other related measures, namely, anxiety, negative affect, and positive affect, it was a significant predictor of stress after controlling for these other constructs. In the follow-up study, calculating HRV when participants reported their most stressful time of the day was less predictive and provided a worse fit (R2=0.022) than the work hours time window (R2=0.032). Conclusions: A significant but small relationship between perceived stress and HRV was found. Thus, although HRV is associated with perceived stress in laboratory settings, the strength of that association diminishes in real-life settings. HRV might be more reflective of perceived stress in the presence of specific and isolated stressors and research-grade sensing. Relying on wearable-derived HRV alone might not be sufficient to detect stress in naturalistic settings and should not be considered a proxy for perceived stress but rather a component of a complex phenomenon. ",
doi="10.2196/33754",
url="https://humanfactors.jmir.org/2022/3/e33754",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925662"
}


@Article{info:doi/10.2196/37195,
author="Sch{\"o}nfeld, Simone
and Rathmer, Ines
and Michaelsen, M. Maren
and Hoetger, Cosima
and Onescheit, Miriam
and Lange, Silke
and Werdecker, Lena
and Esch, Tobias",
title="Effects of a Mindfulness Intervention Comprising an App, Web-Based Workshops, and a Workbook on Perceived Stress Among Nurses and Nursing Trainees: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="2",
volume="11",
number="8",
pages="e37195",
keywords="nurses",
keywords="nursing trainee",
keywords="nursing student",
keywords="acute care",
keywords="inpatient",
keywords="health promotion",
keywords="mindfulness",
keywords="mobile",
keywords="web-based",
keywords="stress",
keywords="mobile phone",
abstract="Background: Previous research has found digitally supported mindfulness interventions to be effective when used for stress management among workers in high-stress occupations. Findings on digitally supported mindfulness interventions among nurses working in acute inpatient care settings are heterogeneous, lack long-term follow-up, and do not assess adherence and acceptability. Objective: This study aimed to investigate the effectiveness and efficacy of a digitally supported mindfulness intervention designed to improve health- and work-related outcomes among nurses and nursing trainees working in acute inpatient care settings. Methods: We will conduct a multicenter randomized controlled trial using a wait-list control group design. Randomization will be stratified by hospital and job status (nurse or nursing trainee). Recruitment will take place on the web and offline during the working hours of nurses and nursing trainees. The intervention group will receive a digitally supported mindfulness intervention, which will comprise an app, 2 web-based workshops, and a workbook, whereas the wait-list control group will be scheduled to receive the same intervention 14 weeks later. The 2 web-based workshops will be led by a certified mindfulness-based stress reduction trainer. Nurses will use the app and the workbook independently. Self-report web-based surveys will be conducted on the web at baseline, at 10 weeks after allocation, at 24 weeks after allocation, and at 38 weeks after allocation. Outcomes of interest will include perceived stress (primary outcome), health- and work-related variables, and variables related to adherence and acceptability of the digitally supported mindfulness intervention. We will perform intention-to-treat and per-protocol analyses. Results: Data collection will be completed by the beginning of August 2022. Data analyses will be completed by December 2022. Conclusions: Our study design, including long-term follow-up and the investigation of variables related to adherence and acceptability, will ensure rigorous evaluation of effectiveness and efficacy. Relative to costly in-person intervention efforts, this program may present a cost-effective and potentially highly scalable alternative. Findings regarding effectiveness, efficacy, adherence, and acceptability will inform stakeholders' decisions regarding the implementation of similar interventions to promote the well-being of nurses and nursing trainees, which may, in turn, alleviate detrimental stress-related outcomes (eg, burnout) because of work-related demands. Trial Registration: German Clinical Trials Register DRKS00025997; https://tinyurl.com/433cas7u International Registered Report Identifier (IRRID): DERR1-10.2196/37195 ",
doi="10.2196/37195",
url="https://www.researchprotocols.org/2022/8/e37195",
url="http://www.ncbi.nlm.nih.gov/pubmed/35916708"
}


@Article{info:doi/10.2196/34826,
author="Lawrence, Katharine
and Nov, Oded
and Mann, Devin
and Mandal, Soumik
and Iturrate, Eduardo
and Wiesenfeld, Batia",
title="The Impact of Telemedicine on Physicians' After-hours Electronic Health Record ``Work Outside Work'' During the COVID-19 Pandemic: Retrospective Cohort Study",
journal="JMIR Med Inform",
year="2022",
month="Jul",
day="28",
volume="10",
number="7",
pages="e34826",
keywords="telemedicine",
keywords="telehealth",
keywords="eHealth",
keywords="COVID-19",
keywords="EHR",
keywords="electronic health record",
keywords="clinician workload",
keywords="impact",
keywords="transition",
keywords="workload",
keywords="cohort",
keywords="retrospective",
keywords="physician",
keywords="efficient",
keywords="doctor",
keywords="health care professional",
keywords="pandemic",
abstract="Background: Telemedicine as a mode of health care work has grown dramatically during the COVID-19 pandemic; the impact of this transition on clinicians' after-hours electronic health record (EHR)--based clinical and administrative work is unclear. Objective: This study assesses the impact of the transition to telemedicine during the COVID-19 pandemic on physicians' EHR-based after-hours workload (ie, ``work outside work'') at a large academic medical center in New York City. Methods: We conducted an EHR-based retrospective cohort study of ambulatory care physicians providing telemedicine services before the pandemic, during the acute pandemic, and after the acute pandemic, relating EHR-based after-hours work to telemedicine intensity (ie, percentage of care provided via telemedicine) and clinical load (ie, patient load per provider). Results: A total of 2129 physicians were included in this study. During the acute pandemic, the volume of care provided via telemedicine significantly increased for all physicians, whereas patient volume decreased. When normalized by clinical load (ie, average appointments per day by average clinical days per week), telemedicine intensity was positively associated with work outside work across time periods. This association was strongest after the acute pandemic. Conclusions: Taking physicians' clinical load into account, physicians who devoted a higher proportion of their clinical time to telemedicine throughout various stages of the pandemic engaged in higher levels of EHR-based after-hours work compared to those who used telemedicine less intensively. This suggests that telemedicine, as currently delivered, may be less efficient than in-person--based care and may increase the after-hours work burden of physicians. ",
doi="10.2196/34826",
url="https://medinform.jmir.org/2022/7/e34826",
url="http://www.ncbi.nlm.nih.gov/pubmed/35749661"
}


@Article{info:doi/10.2196/35290,
author="Ikegami, Kazunori
and Yoshimoto, Yasuro
and Baba, Hiroka
and Sekoguchi, Shingo
and Ando, Hajime
and Ogami, Akira",
title="Study Protocol and Preliminary Results of the Impact of Occupational Health Workers' Activities on Their Health: Nationwide Prospective Internet-Based Survey",
journal="JMIR Form Res",
year="2022",
month="Jul",
day="28",
volume="6",
number="7",
pages="e35290",
keywords="Japan",
keywords="occupational health",
keywords="worker",
keywords="internet surveys",
keywords="questionnaires",
keywords="cohort study",
keywords="COVID-19",
keywords="mental health",
keywords="online health",
abstract="Background: Owing to the impact of the COVID-19 pandemic, work environments and systems, as well as occupational health measures or activities that fall within our research field, are constantly changing. It is necessary to assess the impact of these changes on the physical and mental health of workers. Objective: To assess how occupational health measures affect the health of workers, we conducted a baseline, longitudinal internet-based survey among Japanese workers in October 2021 and additionally scheduled 2 follow-up surveys for 2022 and 2023. We describe the details of the protocol of the work systems and health internet research (WSHIR) study, provide an overview of the results of the baseline survey, and discuss the study procedures and data used in the study. Methods: This prospective cohort study was conducted online among internet monitors. The baseline survey was conducted from October 1 to 7, 2021. This study targeted those who were working and between the ages of 20 and 69 years. A total of 5111 respondents who passed the screening survey and proceeded to the main survey were enrolled according to collection units organized by sex and age. For the screening and main surveys, the questionnaire consisted of 9 and 33 items with 9 and 55 questions, respectively.  Consistency and completeness checks were performed after the questionnaires were submitted. We compared basic characteristics, such as sex, age group, educational background, and marital status, among all participants, including those who withdrew from the analysis. Results: Of the 5111 initial survey respondents, 571 (11.2\%) were considered fraudulent. The data of the remaining 4540 (88.8\%) participants (2273, 50.1\%, males; 2267, 49.9\%, females) included in the analysis were well balanced across participant sex and age groups according to the sampling plan because there was no significant difference by sex and age group using the chi-square test for checking the distribution bias of the participants (P=.84). Compared to female participants, male participants tended to be more likely to be managers and supervisors (323, 14.2\%, males; 86, 3.8\%, females), to work in a secondary industry (742, 32.6\%, males; 357, 15.7\%, females), and to have an annual income of ?5 million yen (976, 42.9\%, males; 429, 18.9\%, females). For the evaluation of a psychological indicator, Kessler 6 (K6) score, by sex and age group, the characteristics of the score distribution of the included participants were similar to those reported in previous studies. Conclusions: This study presents a protocol and overview of the results of an internet-based occupational health survey of workers. Using the results of this survey, we hope to evaluate the changes in occupational health activities and their impact on workers' health while controlling for the COVID-19 pandemic. ",
doi="10.2196/35290",
url="https://formative.jmir.org/2022/7/e35290",
url="http://www.ncbi.nlm.nih.gov/pubmed/35900807"
}


@Article{info:doi/10.2196/36012,
author="Sado, Mitsuhiro
and Yamada, Masashi
and Ninomiya, Akira
and Nagaoka, Maki
and Goto, Naho
and Koreki, Akihiro
and Nakagawa, Atsuo
and Segal, Zindel
and Mimura, Masaru",
title="Effectiveness and Cost-effectiveness of Online Brief Mindfulness-based Cognitive Therapy for the Improvement of Productivity in the Workplace: Study Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="13",
volume="11",
number="6",
pages="e36012",
keywords="mindfulness-based cognitive therapy",
keywords="mindfulness",
keywords="cognitive therapy",
keywords="occupational health",
keywords="workplace",
keywords="randomized controlled trial",
keywords="cost-effectiveness",
keywords="cost",
keywords="online",
keywords="internet-based",
keywords="eHealth",
keywords="mental health",
keywords="heath outcome",
keywords="work",
keywords="stress",
keywords="burnout",
keywords="productivity",
keywords="employee",
abstract="Background: Numerous studies have demonstrated the effectiveness of mindfulness-based programs (MBPs) among both clinical and nonclinical populations. These data document positive impacts in the workplace, including reducing perceived stress and burnout and increasing well-being. However, the effectiveness for productivity, which is of most interest to managers and administrators, is still unclear. In addition, MBPs in the workplace tend to be modified by reducing the number of the program sessions or delivering content online to improve accessibility. To date, however, the impact of MBPs that feature these modifications on productivity in the workplace has not been investigated. Objective: The study aims to investigate the effectiveness and cost-effectiveness of online-delivered brief mindfulness-based cognitive therapy (bMBCT) for improving productivity and other work-related outcomes among healthy workers compared to the waitlist control. Methods: We will conduct a 4-week randomized controlled trial (RCT) with a 6-month follow-up. Employees are included in the study if they (1) are between the ages of 20 and 65 years and (2) work longer than 30 hours weekly. Employees are randomly allocated to either the bMBCT group or the waitlist control group. The primary outcome of the study is the mean difference of productivity measured by the World Health Organization Health and Work Performance Questionnaire (WHO-HPQ) between the groups at 4, 16, and 28 weeks. Secondary outcomes include several clinical outcomes and health economics evaluation. Results: We started recruiting participants in August 2021, and the intervention began in October 2021. A total of 104 participants have been enrolled in the study as of October 2021. The intervention is scheduled to be completed in December 2023. Data collection will be completed by the end of January 2024. Conclusions: The novelty of the study is that (1) it will investigate bMBCT's effectiveness on productivity, which is still unclear, and (2) samples are recruited from 3 companies in different industries. The limitations of the study are that (1) all measures assessed are in self-report format and (2) we lack an active control group. This study has the potential to provide new data on the relationship between MBPs and occupational health and productivity. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000044721; https://tinyurl.com/4e2fh873 International Registered Report Identifier (IRRID): DERR1-10.2196/36012 ",
doi="10.2196/36012",
url="https://www.researchprotocols.org/2022/6/e36012",
url="http://www.ncbi.nlm.nih.gov/pubmed/35387762"
}


@Article{info:doi/10.2196/34951,
author="Pace, W. Thaddeus W.
and Zeiders, H. Katharine
and Cook, H. Stephanie
and Sarsar, D. Evelyn
and Hoyt, T. Lindsay
and Mirin, L. Nicholas
and Wood, P. Erica
and Tatar, Raquel
and Davidson, J. Richard",
title="Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Meditation Intervention to Decrease Firefighter Psychological Distress and Burnout: A One-Group Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="8",
volume="6",
number="6",
pages="e34951",
keywords="firefighter",
keywords="meditation",
keywords="smartphone app",
keywords="anxiety",
keywords="cortisol",
keywords="digital health",
keywords="mobile health",
keywords="mHealth",
keywords="mental health",
keywords="burnout",
keywords="stress management",
abstract="Background: Firefighters are often exposed to occupational stressors that can result in psychological distress (ie, anxiety and depression) and burnout. These occupational stressors have only intensified with the onset of the COVID-19 pandemic and will likely persist in the postpandemic world. Objective: To address occupational stressors confronting firefighters, we pilot tested a novel, cost-effective, smartphone app--based meditation intervention created by Healthy Minds Innovations that focused on mindfulness (awareness) training along with practices designed to cultivate positive relationships (connection), insight into the nature of the self (insight), and a sense of purpose in the context of challenge (purpose) with a sample of professional firefighters from a large metropolitan area in southwestern United States. Methods: A total of 35 participants were recruited from a closed online group listserv and completed the self-guided 10-unit meditation app over the course of 10 days, at 1 unit per day. We assessed anxiety symptoms, depression symptoms, burnout, and negative affect as well as saliva diurnal cortisol rhythm, an objective indicator of stress-related biology, before and after use of the meditation app. Results: This study demonstrated the meditation app was both feasible and acceptable for use by the majority of firefighters. We also found significant reductions in firefighters' anxiety (P=.01), burnout (P=.05), and negative affect (P=.04), as well as changes in cortisol diurnal rhythm, such as waking cortisol (P=.02), from before to after use of the meditation app. Conclusions: Our study findings call for future research to demonstrate the efficacy of this meditation app to reduce psychological distress and burnout in firefighters. ",
doi="10.2196/34951",
url="https://formative.jmir.org/2022/6/e34951",
url="http://www.ncbi.nlm.nih.gov/pubmed/35675115"
}


@Article{info:doi/10.2196/34479,
author="Bernard, M. Renaldo
and Toppo, Claudia
and Raggi, Alberto
and de Mul, Marleen
and de Miquel, Carlota
and Pugliese, Teresa Maria
and van der Feltz-Cornelis, M. Christina
and Ortiz-Tallo, Ana
and Salvador-Carulla, Luis
and Lukersmith, Sue
and Hakkaart-van Roijen, Leona
and Merecz-Kot, Dorota
and Staszewska, Kaja
and Sabariego, Carla",
title="Strategies for Implementing Occupational eMental Health Interventions: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="1",
volume="24",
number="6",
pages="e34479",
keywords="implementation",
keywords="mobile health",
keywords="mHealth",
keywords="mental health",
keywords="eMental health",
keywords="occupational health",
keywords="barriers",
keywords="facilitators",
keywords="scoping review",
keywords="mobile phone",
abstract="Background: The implementation of eMental health interventions, especially in the workplace, is a complex process. Therefore, learning from existing implementation strategies is imperative to ensure improvements in the adoption, development, and scalability of occupational eMental health (OeMH) interventions. However, the implementation strategies used for these interventions are often undocumented or inadequately reported and have not been systematically gathered across implementations in a way that can serve as a much-needed guide for researchers. Objective: The objective of this scoping review was to identify implementation strategies relevant to the uptake of OeMH interventions that target employees and detail the associated barriers and facilitation measures. Methods: A scoping review was conducted. The descriptive synthesis was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and the Consolidated Framework for Implementation Research. Results: A total of 31 of 32,916 (0.09\%) publications reporting the use of the web-, smartphone-, telephone-, and email-based OeMH interventions were included. In all, 98 implementation strategies, 114 barriers, and 131 facilitators were identified. The synthesis of barriers and facilitators produced 19 facilitation measures that provide initial recommendations for improving the implementation of OeMH interventions. Conclusions: This scoping review represents one of the first steps in a research agenda aimed at improving the implementation of OeMH interventions by systematically selecting, shaping, evaluating, and reporting implementation strategies. There is a dire need for improved reporting of implementation strategies and combining common implementation frameworks with more technology-centric implementation frameworks to fully capture the complexities of eHealth implementation. Future research should investigate a wider range of common implementation outcomes for OeMH interventions that also focus on a wider set of common mental health problems in the workplace. This scoping review's findings can be critically leveraged by discerning decision-makers to improve the reach, effectiveness, adoption, implementation, and maintenance of OeMH interventions. ",
doi="10.2196/34479",
url="https://www.jmir.org/2022/6/e34479",
url="http://www.ncbi.nlm.nih.gov/pubmed/35648457"
}


@Article{info:doi/10.2196/34655,
author="Scheutzow, Johanna
and Attoe, Chris
and Harwood, Joshua",
title="Acceptability of Web-Based Mental Health Interventions in the Workplace: Systematic Review",
journal="JMIR Ment Health",
year="2022",
month="May",
day="11",
volume="9",
number="5",
pages="e34655",
keywords="acceptability",
keywords="e-mental health",
keywords="online mental health interventions",
keywords="occupational online interventions",
keywords="employees",
keywords="mobile phone",
abstract="Background: Web-based interventions have proven to be effective not only in clinical populations but also in the occupational setting. Recent studies conducted in the work environment have focused on the effectiveness of these interventions. However, the role of employees' acceptability of web-based interventions and programs has not yet enjoyed a similar level of attention. Objective: The objective of this systematic review was to conduct the first comprehensive study on employees' level of acceptability of web-based mental health interventions based on direct and indirect measures, outline the utility of different types of web-based interventions for work-related mental health issues, and build a research base in the field. Methods: The search was conducted between October 2018 and July 2019 and allowed for any study design. The studies used either qualitative or quantitative data sources. The web-based interventions were generally aimed at supporting employees with their mental health issues. The study characteristics were outlined in a table as well as graded based on their quality using a traffic light schema. The level of acceptability was individually rated using commonly applied methods, including percentile quartiles ranging from low to very high. Results: A total of 1303 studies were identified through multiple database searches and additional resources, from which 28 (2\%) were rated as eligible for the synthesis. The results of employees' acceptability levels were mixed, and the studies were very heterogeneous in design, intervention characteristics, and population. Approximately 79\% (22/28) of the studies outlined acceptability measures from high to very high, and 54\% (15/28) of the studies reported acceptability levels from low to moderate (overlap when studies reported both quantitative and qualitative results). Qualitative studies also provided insights into barriers and preferences, including simple and tailored application tools as well as the preference for nonstigmatized language. However, there were multiple flaws in the methodology of the studies, such as the blinding of participants and personnel. Conclusions: The results outline the need for further research with more homogeneous acceptability studies to draw a final conclusion. However, the underlying results show that there is a tendency toward general acceptability of web-based interventions in the workplace, with findings of general applicability to the use of web-based mental health interventions. ",
doi="10.2196/34655",
url="https://mental.jmir.org/2022/5/e34655",
url="http://www.ncbi.nlm.nih.gov/pubmed/35544305"
}


@Article{info:doi/10.2196/34808,
author="Khuntia, Jiban
and Ning, Xue
and Cascio, Wayne
and Stacey, Rulon",
title="Valuing Diversity and Inclusion in Health Care to Equip the Workforce: Survey Study and Pathway Analysis",
journal="JMIR Form Res",
year="2022",
month="May",
day="6",
volume="6",
number="5",
pages="e34808",
keywords="health system",
keywords="workforce",
keywords="workplace",
keywords="diversity",
keywords="inclusion",
keywords="improve",
keywords="recruit",
keywords="collaborate",
keywords="health care",
keywords="worker",
keywords="employee",
keywords="CEO",
keywords="chief executive officer",
keywords="United States",
keywords="North America",
keywords="characteristic",
keywords="benefit",
keywords="influence",
keywords="strategy",
keywords="pathway",
keywords="hiring",
keywords="hire",
keywords="collaboration",
keywords="talent",
keywords="student",
abstract="Background: The COVID-19 pandemic, with all its virus variants, remains a serious situation. Health systems across the United States are trying their best to respond. On average, the health care workforce is relatively homogenous, even though it cares for a highly diverse array of patients. This perennial problem in the US health care workforce has only been accentuated during the COVID-19 pandemic. Medical workers should reflect on the variety of patients they care for and strive to understand their mindsets within the larger contexts of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities. Along with talent and skills, diversity and inclusion (D\&I) are essential for maintaining a workforce that can treat the myriad needs and populations that health systems serve. Developing hiring strategies that will help achieve greater workforce diversity remains a challenge for health system leaders. Objective: The primary aims of this study were to: (1) explore the characteristics of US health systems and their associations with D\&I practices and benefits, (2) examine the associations between D\&I practices and three pathways to equip workforces, and (3) examine the associations between the three pathways to better equip workforces and business and service benefits. The three pathways are: (1) improving D\&I among existing employees (IMPROVE), (2) using multiple channels to find and recruit the workforce (RECRUIT), and (3) collaborating with universities to find new talent and establish plans to train students (COLLABORATE). Methods: During February to March 2021, 625 health systems in the United States were surveyed with the help of a consultant, 135 (21.6\%) of whom responded. We assessed workforce talent- and diversity-relevant factors. We collected secondary data from the Agency for Healthcare Research and Quality Compendium of the US Health Systems, leading to a matched data set of 124 health systems for analysis. We first explored differences in diversity practices and benefits across the health systems. We then examined the relationships among diversity practices, pathways, and benefits. Results: Health system characteristics such as size, location, ownership, teaching, and revenue have varying associations with diversity practices and outcomes. D\&I and talent strategies exhibited different associations with the three workforce pathways. Regarding the mediating effects, the IMPROVE pathway seems to be more effective than the RECRUIT and COLLABORATE pathways, enabling the diversity strategy to prompt business or service benefits. Moreover, these pathway effects go hand-in-hand with a talent strategy, indicating that both talent and diversity strategies need to be aligned to achieve the best results for a health system. Conclusions: Diversity and talent plans can be aligned to realize multiple desired benefits for health systems. However, a one-size-fits-all approach is not a viable strategy for improving D\&I. Health systems need to follow a multipronged approach based on their characteristics. To get D\&I right, proactive plans and genuine efforts are essential. ",
doi="10.2196/34808",
url="https://formative.jmir.org/2022/5/e34808",
url="http://www.ncbi.nlm.nih.gov/pubmed/35452404"
}


@Article{info:doi/10.2196/34394,
author="Jones, Chelsea
and Smith-MacDonald, Lorraine
and Pike, Ashley
and Bright, Katherine
and Bremault-Phillips, Suzette",
title="Workplace Reintegration Facilitator Training Program for Mental Health Literacy and Workplace Attitudes of Public Safety Personnel: Pre-Post Pilot Cohort Study",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="26",
volume="6",
number="4",
pages="e34394",
keywords="public safety personnel",
keywords="mental health",
keywords="return to work",
keywords="reintegration",
keywords="first responders",
abstract="Background: Public safety personnel (PSP) impacted by operational stress injuries can find themselves needing both time off work and support reintegrating back into the workforce. Work reintegration programs have been introduced in PSP organizations to support those who aim to return to work. One such peer-led workplace reintegration program (RP) was created in 2009 by members of the Edmonton Police Service (EPS). The primary goal of the EPSRP is to assist PSP in returning to work as soon as possible following a critical incident, illness, or injury while diminishing the potential for long-term psychological injury. The EPSRP is delivered by peers through 3 interrelated components: (1) the Reintegration Program Facilitator Training (RPFT) Program; (2) a short-term Critical Incident RP; and (3) a long-term RP. There is a dire need for research that incorporates strong study designs to the determine long-term effectiveness of the program on increasing workplace reintegration, improving mental health knowledge, and creating culture change within PSP organizations. Simultaneously, the efficacy, effectiveness, and fidelity of the RPFT in providing the tools, mental health knowledge, and skills the RP peer facilitators will need for the RP must be evaluated. Objective: The purpose of this quasi-experimental pre-post pilot cohort study is to evaluate the effectiveness of the EPSRPFT course on influencing mental health knowledge and attitudes of RPFT attendees who will be future RP peer facilitators. Methods: This pre-post cohort study collected data via 2 questionnaires from RPFT participants (N=60) which included the Mental Health Knowledge Survey (MAKS) and the Open Minds Survey of Workplace Attitudes (OMSWA). Descriptive, parametric (sample t tests), and nonparametric (Wilcoxon signed rank tests) statistics were used to compare the pre- and post-RPFT results and to analyze results by gender and profession. Results: Statistically significant changes were observed in pre-post questionnaire scores in the domains of mental health attitudes and knowledge. Conclusions: Although results are explorative, the RPFT may facilitate positive changes in workplace mental health attitudes and knowledge among PSP. It is hoped these findings will contribute to a broader evidence base that can inform changes to the program, practices, and policies, and inform decision-making regarding the EPSRP. ",
doi="10.2196/34394",
url="https://formative.jmir.org/2022/4/e34394",
url="http://www.ncbi.nlm.nih.gov/pubmed/35471413"
}


@Article{info:doi/10.2196/34005,
author="Egan, A. Luke
and Mulcahy, Mary
and Tuqiri, Karen
and Gatt, M. Justine",
title="A Web-Based Well-being Program for Health Care Workers (Thrive): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="21",
volume="11",
number="4",
pages="e34005",
keywords="well-being",
keywords="Composure, Own-worth, Mastery, Positivity, Achievement, and Satisfaction for Wellbeing",
keywords="COMPAS-W",
keywords="mental health",
keywords="resilience",
keywords="health care",
keywords="hospital",
keywords="brain",
keywords="neuroscience",
keywords="online",
keywords="randomized controlled trial",
keywords="RCT",
abstract="Background: Mental health has come to be understood as not merely the absence of mental illness but also the presence of mental well-being, and recent interventions have sought to increase well-being in various populations. A population that deserves particular attention is that of health care workers, whose occupations entail high levels of stress, especially given the ongoing COVID-19 pandemic. A neuroscience-based web-based well-being program for health care workers---the Thrive program---has been newly developed to promote habits and activities that contribute to brain health and overall mental well-being. Objective: This paper describes the protocol for a randomized controlled trial whose objective is to evaluate the Thrive program in comparison with an active control condition to measure whether the program is effective at increasing well-being and decreasing symptoms of psychological distress in health care workers at a designated Australian hospital. Methods: The trial will comprise two groups (intervention vs active control) and 4 measurement occasions over a 12-week period. A survey will be administered in each of weeks 0, 4, 8, and 12, and the well-being program will be delivered in weeks 1-7 (via web-based video presentations or digital pamphlets). Each of the 4 surveys will comprise a range of questionnaires to measure well-being, psychological distress, and other key variables. The planned analyses will estimate group-by-time interaction effects to test the hypothesis that mental health will increase over time in the intervention condition relative to the active control condition. Results: The Thrive program was delivered to a small number of wards at the hospital between February 2021 and July 2021, and it will be delivered to the remaining wards from October 2021 to December 2021. A power calculation has recommended a sample size of at least 200 participants in total. A linear mixed model will be used to estimate the interaction effects. Conclusions: This trial seeks to evaluate a new web-based well-being program for health care workers at a major public hospital. It will contribute to the growing body of research on mental well-being and ways to promote it. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000027819; https://tinyurl.com/58wwjut9 International Registered Report Identifier (IRRID): DERR1-10.2196/34005 ",
doi="10.2196/34005",
url="https://www.researchprotocols.org/2022/4/e34005",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451973"
}


@Article{info:doi/10.2196/36166,
author="H{\"o}per, Christina Anje
and Terjesen, Lilja Christoffer
and Fleten, Nils",
title="Comparing the New Interdisciplinary Health in Work Intervention With Conventional Monodisciplinary Welfare Interventions at Norwegian Workplaces: Protocol for a Pragmatic Cluster Randomized Trial",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="7",
volume="11",
number="4",
pages="e36166",
keywords="sickness absence",
keywords="work environment",
keywords="work environment intervention",
keywords="health related quality of life",
keywords="cluster randomized trial",
keywords="cost-effectiveness-analysis",
keywords="cost-benefit-analysis",
keywords="health in work",
abstract="Background: Musculoskeletal and mental health complaints are the dominant diagnostic categories in long-term sick leave and disability pensions in Norway. Continuing to work despite health complaints is often beneficial, and a good work environment can improve work inclusion for people affected. In 2001, the Norwegian Labour and Welfare Administration began to offer inclusive work measures to improve the psychosocial work environment and work inclusion of people with health complaints. In 2018, the Norwegian Labour and Welfare Administration and specialist health services started offering the new collaborative Health in work program. Its workplace intervention presents health and welfare information that may improve employees' coping ability regarding common health complaints. It encourages understanding of coworkers' health complaints and appropriate work adjustments to increase work participation. Objective: This protocol presents an ongoing, 2-arm, pragmatic cluster-randomized trial. Its aim is to compare the effect of monodisciplinary inclusive work measures (treatment as usual) and interdisciplinary Health in work in terms of changes in overall sickness absence, health care use, health-related quality of life, and costs. The secondary objectives are to compare changes in individual sickness absence, psychosocial work environment, job and life satisfaction, health, and health anxiety at both the individual and group levels. Methods: Data will be collected from national registers, trial-specific registrations, and questionnaires. Effects will be explored using difference-in-difference analysis and regression modeling. Multilevel analysis will visualize any cluster effects using intraclass correlation coefficients. Results: Inclusion was completed in July 2021 with 97 workplaces and 1383 individual consents. Data collection will be completed with the last questionnaires to be sent out in July 2023. Conclusions: This trial will contribute to filling knowledge gaps regarding the effectiveness and costs of workplace interventions, thereby benefiting health and welfare services, political decision makers, and the public and business sectors. The findings will be disseminated in reports, peer-reviewed journals, and conferences. Trial Registration: ClinicalTrials.gov NCT04000035; https://clinicaltrials.gov/ct2/show/NCT04000035 International Registered Report Identifier (IRRID): DERR1-10.2196/36166 ",
doi="10.2196/36166",
url="https://www.researchprotocols.org/2022/4/e36166",
url="http://www.ncbi.nlm.nih.gov/pubmed/35388792"
}


@Article{info:doi/10.2196/36200,
author="Kruse, Scott Clemens
and Mileski, Michael
and Dray, Gevin
and Johnson, Zakia
and Shaw, Cameron
and Shirodkar, Harsha",
title="Physician Burnout and the Electronic Health Record Leading Up to and During the First Year of COVID-19: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="31",
volume="24",
number="3",
pages="e36200",
keywords="electronic health record",
keywords="physician burnout",
keywords="quality improvement",
keywords="psychiatry",
keywords="medical informatics",
keywords="COVID-19",
keywords="pandemic",
keywords="health informatic",
keywords="health care",
keywords="health care professional",
keywords="health care infrastructure",
keywords="health care system",
keywords="mental health",
keywords="cognitive fatigue",
abstract="Background: Physician burnout was first documented in 1974, and the electronic health record (EHR) has been known to contribute to the symptoms of physician burnout. Authors pondered the extent of this effect, recognizing the increased use of telemedicine during the first year of COVID-19. Objective: The aim of this review was to objectively analyze the literature over the last 5 years for empirical evidence of burnout incident to the EHR and to identify barriers to, facilitators to, and associated patient satisfaction with using the EHR to improve symptoms of burnout. Methods: No human participants were involved in this review; however, 100\% of participants in studies analyzed were adult physicians. We queried 4 research databases and 1 targeted journal for studies commensurate with the objective statement from January 1, 2016 through January 31, 2021 (n=25). Results: The hours spent in documentation and workflow are responsible for the sense of loss of autonomy, lack of work-life balance, lack of control of one's schedule, cognitive fatigue, a general loss of autonomy, and poor relationships with colleagues. Researchers have identified training, local customization of templates and workflow, and the use of scribes as strategies to alleviate the administrative burden of the EHR and decrease symptoms of burnout. Conclusions: The solutions provided in the literature only addressed 2 of the 3 factors (workflow and documentation time) but not the third factor (usability). Practitioners and administrators should focus on the former 2 factors because they are within their sphere of control. EHR vendors should focus on empirical evidence to identify and improve the usability features with the greatest impact. Researchers should design experiments to explore solutions that address all 3 factors of the EHR that contribute to burnout. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020201820; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=201820 International Registered Report Identifier (IRRID): RR2-10.2196/15490 ",
doi="10.2196/36200",
url="https://www.jmir.org/2022/3/e36200",
url="http://www.ncbi.nlm.nih.gov/pubmed/35120019"
}


@Article{info:doi/10.2196/30966,
author="Cederberg, Matilda
and Als{\'e}n, Sara
and Ali, Lilas
and Ekman, Inger
and Glise, Kristina
and Jonsdottir, H. Ingibj{\"o}rg
and Gyllensten, Hanna
and Swedberg, Karl
and Fors, Andreas",
title="Effects of a Person-Centered eHealth Intervention for Patients on Sick Leave Due to Common Mental Disorders (PROMISE Study): Open Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2022",
month="Mar",
day="15",
volume="9",
number="3",
pages="e30966",
keywords="depression",
keywords="anxiety",
keywords="stress",
keywords="patient-centered care",
keywords="person-centered care",
keywords="telehealth",
keywords="mHealth",
keywords="sickness absence",
keywords="intervention",
keywords="randomized controlled trial",
keywords="mobile phone",
abstract="Background: Sick leave due to common mental disorders (CMDs) is a public health problem in several countries, including Sweden. Given that symptom relief does not necessarily correspond to return to work, health care interventions focusing on factors that have proven important to influence the return to work process, such as self-efficacy, are warranted. Self-efficacy is also a central concept in person-centered care. Objective: The aim of this study is to evaluate the effects of a person-centered eHealth intervention for patients on sick leave due to CMDs. Methods: A randomized controlled trial of 209 patients allocated to either a control group (107/209, 51.2\%) or an intervention group (102/209, 48.8\%) was conducted. The control group received usual care, whereas the intervention group received usual care with the addition of a person-centered eHealth intervention. The intervention was built on person-centered care principles and consisted of telephone support and a web-based platform. The primary outcome was a composite score of changes in general self-efficacy (GSE) and level of sick leave at the 6-month follow-up. An intention-to-treat analysis included all participants, and a per-protocol analysis consisted of those using both the telephone support and the web-based platform. Results: At the 3-month follow-up, in the intention-to-treat analysis, more patients in the intervention group improved on the composite score than those in the control group (20/102, 19.6\%, vs 10/107, 9.3\%; odds ratio [OR] 2.37, 95\% CI 1.05-5.34; P=.04). At the 6-month follow-up, the difference was no longer significant between the groups (31/100, 31\%, vs 25/107, 23.4\%; OR 1.47, 95\% CI 0.80-2.73; P=.22). In the per-protocol analysis, a significant difference was observed between the intervention and control groups at the 3-month follow-up (18/85, 21.2\%, vs 10/107, 9.3\%; OR 2.6, 95\% CI 1.13-6.00; P=.02) but not at 6 months (30/84, 35.7\%, vs 25/107, 23.4\%; OR 1.8, 95\% CI 0.97-3.43; P=.06). Changes in GSE drove the effects in the composite score, but the intervention did not affect the level of sick leave. Conclusions: A person-centered eHealth intervention for patients on sick leave due to CMDs improved GSE but did not affect the level of sick leave. Trial Registration: ClinicalTrials.gov NCT03404583; https://clinicaltrials.gov/ct2/show/NCT03404583 ",
doi="10.2196/30966",
url="https://mental.jmir.org/2022/3/e30966",
url="http://www.ncbi.nlm.nih.gov/pubmed/35289756"
}


@Article{info:doi/10.2196/33571,
author="Turesson, Christina
and Liedberg, Gunilla
and Bj{\"o}rk, Mathilda",
title="Development of a Digital Support Application With Evidence-Based Content for Sustainable Return to Work for Persons With Chronic Pain and Their Employers: User-Centered Agile Design Approach",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="14",
volume="9",
number="1",
pages="e33571",
keywords="agile design process",
keywords="chronic pain",
keywords="digital support",
keywords="eHealth",
keywords="return to work",
keywords="self-management",
keywords="smartphone apps",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: Persons with chronic pain experience a lack of support after completing rehabilitation and the responsibility for the return-to-work (RTW) process is taken over by the employer. In addition, employers describe not knowing how to support their employees. Smartphone apps have been increasingly used for self-management, but there is a lack of available eHealth apps with evidence-based content providing digital support for persons with chronic pain and their employers when they return to work. Objective: This study aims to describe the development of a digital support application with evidence-based content that includes a biopsychosocial perspective on chronic pain for sustainable RTW for persons with chronic pain and their employers (SWEPPE [Sustainable Worker Digital Support for Persons With Chronic Pain and Their Employers]). Methods: A user-centered agile design approach was applied. The multidisciplinary project team consisted of health care researchers, a user representative, and a software team. A total of 2 reference groups of 7 persons with chronic pain and 4 employers participated in the development process and usability testing. Mixed methods were used for data collection. The design was revised using feedback from the reference groups. The content of SWEPPE was developed based on existing evidence and input from the reference groups. Results: The reference groups identified the following as important characteristics to include in SWEPPE: keeping users motivated, tracking health status and work situation, and following progress. SWEPPE was developed as a smartphone app for the persons with chronic pain and as a web application for their employers. SWEPPE consists of six modules: the action plan, daily self-rating, self-monitoring graphs, the coach, the library, and shared information with the employer. The employers found the following functions in SWEPPE to be the most useful: employees' goals related to RTW, barriers to RTW, support wanted from the employer, and the ability to follow employees' progress. The persons with chronic pain found the following functions in SWEPPE to be the most useful: setting a goal related to RTW, identifying barriers and strategies, and self-monitoring. Usability testing revealed that SWEPPE was safe, useful (ie, provided relevant information), logical, and easy to use with an appealing interface. Conclusions: This study reports the development of a digital support application for persons with chronic pain and their employers. SWEPPE fulfilled the need of support after an interdisciplinary pain rehabilitation program with useful functions such as setting a goal related to RTW, identification of barriers and strategies for RTW, self-monitoring, and sharing information between the employee and the employer. The user-centered agile design approach contributed to creating SWEPPE as a relevant and easy-to-use eHealth intervention. Further studies are needed to examine the effectiveness of SWEPPE in a clinical setting. ",
doi="10.2196/33571",
url="https://humanfactors.jmir.org/2022/1/e33571",
url="http://www.ncbi.nlm.nih.gov/pubmed/35285814"
}


@Article{info:doi/10.2196/34152,
author="Haraldsson, Patrik
and Ros, Axel
and Jonker, Dirk
and Areskoug Josefsson, Kristina",
title="Evaluating the Effect of Supported Systematic Work Environment Management During the COVID-19 Pandemic: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="10",
volume="11",
number="3",
pages="e34152",
keywords="occupational health interventions",
keywords="implementation",
keywords="mixed methods",
keywords="COVID-19 pandemic",
keywords="COVID-19",
keywords="pandemic",
keywords="occupational health",
keywords="health interventions",
keywords="health care",
keywords="support services",
keywords="employee health",
abstract="Background: The work environment is a complex phenomenon in which many factors interact. Scientific research indicates a relation between the work environment and employee health, staff turnover, patient satisfaction, and patient safety. There is a great need for knowledge on how to conduct work environment interventions and practical work environment management to maximize benefits to the employees. Objective: The aim of this study is to explore how Occupational Health Service (OHS) support will affect the work environment, sick leave, staff turnover, patient satisfaction, and patient safety during and following the COVID-19 pandemic in a medical ward setting. Methods: A mixed methods evaluation of a concurrent work environment quality improvement project at the Department of Internal Medicine and Geriatrics in a local hospital in the south of Sweden will be performed. Results: The mixed methods evaluation of the quality improvement project received funding from Futurum--Academy for Health and Care, J{\"o}nk{\"o}ping County Council and Region J{\"o}nk{\"o}ping County, and the study protocol was approved by the Swedish Ethical Review Authority. The work environment quality improvement project will continue between May 2020 and December 2021. Conclusions: The study might contribute to increased knowledge of how work environment interventions and practical work environment management can impact the work environment, and employee health, staff turnover, patient satisfaction, and patient safety. There is a need for knowledge in this area for OHS management to provide increased benefits to employees, employers, and society as a whole. International Registered Report Identifier (IRRID): DERR1-10.2196/34152 ",
doi="10.2196/34152",
url="https://www.researchprotocols.org/2022/3/e34152",
url="http://www.ncbi.nlm.nih.gov/pubmed/35234649"
}


@Article{info:doi/10.2196/33451,
author="Simmons, Janie
and Elliott, Luther
and Bennett, S. Alex
and Beletsky, Leo
and Rajan, Sonali
and Anders, Brad
and Dastparvardeh, Nicole",
title="Evaluation of an Experimental Web-based Educational Module on Opioid-related Occupational Safety Among Police Officers: Protocol for a Randomized Pragmatic Trial to Minimize Barriers to Overdose Response",
journal="JMIR Res Protoc",
year="2022",
month="Feb",
day="25",
volume="11",
number="2",
pages="e33451",
keywords="occupational health",
keywords="law enforcement",
keywords="police/education",
keywords="naloxone",
keywords="opioid overdose prevention and response training",
keywords="online education",
keywords="opioids",
keywords="occupational risk",
abstract="Background: As drug-related morbidity and mortality continue to surge, police officers are on the front lines of the North American overdose (OD) crisis. Drug law enforcement shapes health risks among people who use drugs (PWUD), while also impacting the occupational health and wellness of officers. Effective interventions to align law enforcement practices with public health and occupational safety goals remain underresearched. Objective: The Opioids and Police Safety Study (OPS) aims to shift police practices relating to PWUD. It adapts and evaluates the relative effectiveness of a curriculum that bundles content on public health promotion with occupational risk reduction (ORR) to supplement a web-based OD response and naloxone training platform (GetNaloxoneNow.org, or GNN). This novel approach has the potential to improve public health and occupational safety practices, including using naloxone to reverse ODs, referring PWUD to treatment and other supportive services, and avoiding syringe confiscation. Methods: This longitudinal study uses a randomized pragmatic trial design. A sample of 300 active-duty police officers from select counties in Pennsylvania, Vermont, and New Hampshire with high OD fatality rates will be randomized (n=150 each) to either the experimental arm (GNN + OPS) or the control arm (GNN + COVID-19 ORR). A pre- and posttraining survey will be administered to all 300 officers, after which they will be administered quarterly surveys for 12 months. A subsample of police officers will also be qualitatively followed in a simultaneous embedded mixed-methods approach. Research ethics approval was obtained from the New York University Institutional Review Board. Results: Results will provide an understanding of the experiences, knowledge, and perceptions of this sample of law enforcement personnel. Generalized linear models will be used to analyze differences in key behavioral outcomes between the participants in each of the 2 study arms and across multiple time points (anticipated minimum effect size to be detected, d=0.50). Findings will be disseminated widely, and the training products will be available nationally once the study is completed. Conclusions: The OPS is the first study to longitudinally assess the impact of a web-based opioid-related ORR intervention for law enforcement in the U.S. Our randomized pragmatic clinical trial aims to remove barriers to life-saving police engagement with PWUD/people who inject drugs by focusing both on the safety of law enforcement and evidence-based and best practices for working with persons at risk of an opioid OD. Our simultaneous embedded mixed-methods approach will provide empirical evaluation of the diffusion of the naloxone-based response among law enforcement. Trial Registration: ClinicalTrail.gov NCT05008523; https://clinicaltrials.gov/show/NCT05008523 International Registered Report Identifier (IRRID): DERR1-10.2196/33451 ",
doi="10.2196/33451",
url="https://www.researchprotocols.org/2022/2/e33451",
url="http://www.ncbi.nlm.nih.gov/pubmed/35212639"
}


@Article{info:doi/10.2196/35558,
author="Simpson, Naomi
and Steen, Mary
and Vernon, Rachael
and Briley, Annette
and Wepa, Dianne",
title="Developing Conflict Resolution Strategies and Building Resilient Midwifery Students: Protocol for a Mixed Methods Research Study",
journal="JMIR Res Protoc",
year="2022",
month="Feb",
day="18",
volume="11",
number="2",
pages="e35558",
keywords="midwifery students",
keywords="workplace",
keywords="bullying",
keywords="violence",
keywords="conflict",
keywords="abuse",
keywords="resilience",
abstract="Background: Workplace bullying and violence (WBV) are well-documented issues in the midwifery profession. Negative workplace culture, conflict, and bullying are the most common forms of workplace violence experienced by midwives. Workplace violence increases the risk of midwives experiencing burnout, compassion fatigue, psychological trauma, poor mental health, absenteeism, loss of passion for the midwifery profession, job dissatisfaction, and poor job retention. Midwifery students describe workplace violence in the form of physical, emotional, or verbal abuse, and bullying. Therefore, there is a justification to develop conflict resolution strategies and resilience in midwifery students prior to graduation. Objective: Our aim is to develop and facilitate a bespoke education program for South Australian midwifery students to enable them to develop skills in conflict resolution, build resilience, and identify self-care strategies. Methods: This study will undertake a preparatory phase summarizing the body of literature on midwifery students' knowledge, understanding, and experiences of WBV. Following this, a 3-phase sequential mixed methods research design study will be undertaken. In Phase 1, quantitative data will be collected via a semistructured questionnaire and a validated conflict measurement tool, before and after attending an education workshop, and will be analyzed using descriptive and inferential statistics. Results from Phase 1 will inform and guide the development of an interview schedule for Phase 2. In Phase 2, qualitative data will be gathered by facilitating one-to-one interviews and a thematic analysis will be undertaken to gain a deeper understanding of midwifery students' experiences of WBV. In Phase 3, data integration using triangulation will be undertaken and meta-inferences will be developed via the integration of results and findings from Phases 1 and 2. Results: The preparatory phase will commence in October 2021. Phase 1 will commence in 2022 with analysis of pre- and posteducation results anticipated to be completed by December 2022. Phase 2 will be developed from findings of the preparatory phase and results of Phase 1. An interpretation of verbatim interview transcripts is estimated to be undertaken by April 2023. Phase 3 of the study is expected to commence in May 2023, and this will involve the analysis of collective evidence gathered from Phases 1 and 2. The anticipated completion date for the study is December 2023. Conclusions: The outcomes of this research will provide insights into the prevalence and impact of WBV experienced by midwifery students. The findings of the research will report on levels of knowledge, skills, and confidence, and will assess the impact of a bespoke conflict resolution and resilience education workshop for midwifery students in managing WBV. International Registered Report Identifier (IRRID): PRR1-10.2196/35558 ",
doi="10.2196/35558",
url="https://www.researchprotocols.org/2022/2/e35558",
url="http://www.ncbi.nlm.nih.gov/pubmed/34995202"
}


@Article{info:doi/10.2196/30272,
author="Bartlett, Larissa
and Martin, J. Angela
and Kilpatrick, Michelle
and Otahal, Petr
and Sanderson, Kristy
and Neil, L. Amanda",
title="Effects of a Mindfulness App on Employee Stress in an Australian Public Sector Workforce: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="10",
volume="10",
number="2",
pages="e30272",
keywords="mindfulness",
keywords="stress",
keywords="apps",
keywords="smartphone app",
keywords="employee",
keywords="workplace",
keywords="performance",
keywords="mobile phone",
abstract="Background: Workplace-based mindfulness programs have good evidence for improving employee stress and mental health outcomes, but less is known about their effects on productivity and citizenship behaviors. Most of the available evidence is derived from studies of mindfulness programs that use class-based approaches. Mindfulness apps can increase access to training, but whether self-directed app use is sufficient to realize benefits equivalent to class-based mindfulness programs is unknown. Objective: We assessed the effectiveness of a mindfulness app, both with and without supporting classes, for reducing employees' perceived stress. Changes in mindfulness, mental health, quality of life, perceptions of job demand, control and support, productivity indicators, organizational citizenship, and mindful behaviors at work were also investigated. Methods: Tasmanian State Service employees were invited by the Tasmanian Training Consortium to a 3-arm randomized controlled trial investigating the effects of a mindfulness app on stress. The app used in the Smiling Mind Workplace Program formed the basis of the intervention. The app includes lessons, activities, and guided meditations, and is supported by 4 instructional emails delivered over 8 weeks. Engagement with the app for 10-20 minutes, 5 days a week, was recommended. Reported data were collected at baseline (time point 0), 3 months from baseline (time point 1 [T1]), and at 6-month follow-up (time point 2). At time point 0, participants could nominate a work-based observer to answer surveys about participants' behaviors. Eligible participants (n=211) were randomly assigned to self-guided app use plus four 1-hour classes (app+classes: 70/211, 33.2\%), self-guided app use (app-only: 71/211, 33.6\%), or waitlist control (WLC; 70/211, 33.2\%). Linear mixed effects models were used to assess changes in the active groups compared with the WLC at T1 and for a head-to-head comparison of the app+classes and app-only groups at follow-up. Results: App use time was considerably lower than recommended (app+classes: 120/343 minutes; app-only: 45/343 minutes). Compared with the WLC at T1, no significant change in perceived stress was observed in either active group. However, the app+classes group reported lower psychological distress ($\beta$=?1.77, SE 0.75; P=.02; Cohen d=--0.21) and higher mindfulness ($\beta$=.31, SE 0.12; P=.01; Cohen d=0.19). These effects were retained in the app+classes group at 6 months. No significant changes were observed for the app-only group or for other outcomes. There were no significant changes in observer measures at T1, but by time point 2, the app+classes participants were more noticeably mindful and altruistic at work than app-only participants. Conclusions: Including classes in the training protocol appears to have motivated engagement and led to benefits, whereas self-guided app use did not realize any significant results. Effect sizes were smaller and less consistent than meta-estimates for class-based mindfulness training. Trial Registration: Australian New Zealand Clinical Trials Register ACTRN12617001386325; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372942\&isReview ",
doi="10.2196/30272",
url="https://mhealth.jmir.org/2022/2/e30272",
url="http://www.ncbi.nlm.nih.gov/pubmed/35142630"
}


@Article{info:doi/10.2196/30682,
author="Jung, Jiyeon
and Cho, Inhae",
title="Promoting Physical Activity and Weight Loss With mHealth Interventions Among Workers: Systematic Review and Meta-analysis of Randomized Controlled Trials",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="21",
volume="10",
number="1",
pages="e30682",
keywords="mHealth",
keywords="physical activity",
keywords="obesity",
keywords="weight loss",
keywords="workforce",
keywords="workplace health promotion",
keywords="mobile phone",
abstract="Background: Physical activity (PA) is a vital factor in promoting health in the workforce. Mobile health (mHealth) interventions have recently emerged in workplace health promotion as an effective strategy for inducing changes in health behaviors among workers; however, the effectiveness of mHealth interventions in promoting PA and weight loss for workers is unclear. Objective: This study aims to provide a comprehensive analysis of current evidence on the effectiveness of mHealth interventions in promoting PA and weight loss among workers. Methods: We searched relevant databases, including PubMed, Embase, CINAHL Complete, and the Cochrane Library, for publications on mHealth interventions in the English or Korean language from inception to December 2020. Randomized controlled trials that evaluated the effectiveness of mHealth in improving PA and weight loss were retrieved. A meta-analysis with a random effects model and subgroup analyses was performed on PA types and mHealth intervention characteristics. Results: A total of 8 studies were included in this analysis. More than half of the studies (5/8, 63\%) were identified as having a high risk of bias. The mHealth intervention group showed a significant improvement in PA (standardized mean difference [SMD] 0.22, 95\% CI 0.03-0.41; P<.001; I2=78\%). No significant difference in weight loss was observed when comparing the intervention group with the control groups (SMD 0.02, 95\% CI --0.07 to 0.10; P=.48; I2=0\%). A subgroup analysis was also performed; walking activity (SMD 0.70, 95\% CI 0.21-1.19; P<.001; I2=83.3\%), a multicomponent program (SMD 0.19, 95\% CI 0.05-0.33; P=.03; I2=57.4\%), objective measurement (SMD 0.58, 95\% CI 0.05-1.10; P<.001; I2=87.3\%), and 2 or more delivery modes (SMD 0.44, 95\% CI 0.01-0.87; P<.001; I2=85.1\%) were significantly associated with an enhancement in PA. Conclusions: This study suggests that mHealth interventions are effective for improving PA among workers. Future studies that assess long-term efficacy with a larger population are recommended. ",
doi="10.2196/30682",
url="https://mhealth.jmir.org/2022/1/e30682",
url="http://www.ncbi.nlm.nih.gov/pubmed/35060913"
}


@Article{info:doi/10.2196/34103,
author="Sierk, Anika
and Travers, Eoin
and Economides, Marcos
and Loe, Sheng Bao
and Sun, Luning
and Bolton, Heather",
title="A New Digital Assessment of Mental Health and Well-being in the Workplace: Development and Validation of the Unmind Index",
journal="JMIR Ment Health",
year="2022",
month="Jan",
day="17",
volume="9",
number="1",
pages="e34103",
keywords="mental health",
keywords="well-being",
keywords="mHealth",
keywords="measurement",
abstract="Background: Unmind is a workplace, digital, mental health platform with tools to help users track, maintain, and improve their mental health and well-being (MHWB). Psychological measurement plays a key role on this platform, providing users with insights on their current MHWB, the ability to track it over time, and personalized recommendations, while providing employers with aggregate information about the MHWB of their workforce. Objective: Due to the limitations of existing measures for this purpose, we aimed to develop and validate a novel well-being index for digital use, to capture symptoms of common mental health problems and key aspects of positive well-being. Methods: In Study 1A, questionnaire items were generated by clinicians and screened for face validity. In Study 1B, these items were presented to a large sample (n=1104) of UK adults, and exploratory factor analysis was used to reduce the item pool and identify coherent subscales. In Study 2, the final measure was presented to a new nationally representative UK sample (n=976), along with a battery of existing measures, with 238 participants retaking the Umind Index after 1 week. The factor structure and measurement invariance of the Unmind Index was evaluated using confirmatory factor analysis, convergent and discriminant validity by estimating correlations with existing measures, and reliability by examining internal consistency and test-retest intraclass correlations. Results: Studies 1A and 1B yielded a 26-item measure with 7 subscales: Calmness, Connection, Coping, Happiness, Health, Fulfilment, and Sleep. Study 2 showed that the Unmind Index is fitted well by a second-order factor structure, where the 7 subscales all load onto an overall MHWB factor, and established measurement invariance by age and gender. Subscale and total scores correlate well with existing mental health measures and generally diverge from personality measures. Reliability was good or excellent across all subscales. Conclusions: The Unmind Index is a robust measure of MHWB that can help to identify target areas for intervention in nonclinical users of a mental health app. We argue that there is value in measuring mental ill health and mental well-being together, rather than treating them as separate constructs. ",
doi="10.2196/34103",
url="https://mental.jmir.org/2022/1/e34103",
url="http://www.ncbi.nlm.nih.gov/pubmed/35037895"
}


@Article{info:doi/10.2196/30640,
author="Chaudhry, Moalla Beenish
and Islam, Ashraful
and Matthieu, Monica",
title="Toward Designs of Workplace Stress Management Mobile Apps for Frontline Health Workers During the COVID-19 Pandemic and Beyond: Mixed Methods Qualitative Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="13",
volume="6",
number="1",
pages="e30640",
keywords="mental health",
keywords="stress",
keywords="mHealth",
keywords="frontline health worker",
keywords="design requirements",
keywords="pandemic",
keywords="COVID-19",
keywords="design",
keywords="intervention",
keywords="burnout",
keywords="perspective",
keywords="need",
keywords="user design",
abstract="Background: In recent years, mobile apps have been developed to prevent burnout, promote anxiety management, and provide health education to workers in various workplace settings. However, there remains a paucity of such apps for frontline health workers (FHWs), even though FHWs are the most susceptible to stress due to the nature of their jobs. Objective: The goal of this study was to provide suggestions for designing stress management apps to address workplace stressors of FHWs based on the understanding of their needs from FHWs' own perspectives and theories of stress. Methods: A mixed methods qualitative study was conducted. Using a variety of search strings, we first collected 41 relevant web-based news articles published between December 2019 and May 2020 through the Google search engine. We then conducted a cross-sectional survey with 20 FHWs. Two researchers independently conducted qualitative analysis of all the collected data using a deductive followed by an inductive approach. Results: Prevailing uncertainty and fear of contracting the infection was causing stress among FHWs. Moral injury associated with seeing patients die from lack of care and lack of experience in handling various circumstances were other sources of stress. FHWs mentioned 4 coping strategies. Quick coping strategies such as walking away from stressful situations, entertainment, and exercise were the most common ways to mitigate the impact of stress at work. Peer support and counseling services were other popular methods. Building resilience and driving oneself forward using internal motivation were also meaningful ways of overcoming stressful situations. Time constraints and limited management support prevented FHWs from engaging in stress management activities. Conclusions: Our study identified stressors, coping strategies, and challenges with applying coping strategies that can guide the design of stress management apps for FHWs. Given that the pandemic is ongoing and health care crises continue, FHWs remain a vulnerable population in need of attention. ",
doi="10.2196/30640",
url="https://formative.jmir.org/2022/1/e30640",
url="http://www.ncbi.nlm.nih.gov/pubmed/34806985"
}


@Article{info:doi/10.2196/26763,
author="Wang, Hsiao-Han
and Lin, Yu-Hsuan",
title="Assessing Physicians' Recall Bias of Work Hours With a Mobile App: Interview and App-Recorded Data Comparison",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="24",
volume="23",
number="12",
pages="e26763",
keywords="smartphone",
keywords="mobile app",
keywords="work hours",
keywords="recall bias",
keywords="time perception",
keywords="physicians",
keywords="labor policy",
abstract="Background: Previous studies have shown inconsistencies in the accuracy of self-reported work hours. However, accurate documentation of work hours is fundamental for the formation of labor policies. Strict work-hour policies decrease medical errors, improve patient safety, and promote physicians' well-being. Objective: The aim of this study was to estimate physicians' recall bias of work hours with a mobile app, and to examine the association between the recall bias and physicians' work hours. Methods: We quantified recall bias by calculating the differences between the app-recorded and self-reported work hours of the previous week and the penultimate week. We recruited 18 physicians to install the ``Staff Hours'' app, which automatically recorded GPS-defined work hours for 2 months, contributing 1068 person-days. We examined the association between work hours and two recall bias indicators: (1) the difference between self-reported and app-recorded work hours and (2) the percentage of days for which work hours were not precisely recalled during interviews. Results: App-recorded work hours highly correlated with self-reported counterparts (r=0.86-0.88, P<.001). Self-reported work hours were consistently significantly lower than app-recorded hours by --8.97 (SD 8.60) hours and --6.48 (SD 8.29) hours for the previous week and the penultimate week, respectively (both P<.001). The difference for the previous week was significantly correlated with work hours in the previous week (r=--0.410, P=.01), whereas the correlation of the difference with the hours in the penultimate week was not significant (r=--0.119, P=.48). The percentage of hours not recalled (38.6\%) was significantly higher for the penultimate week (38.6\%) than for the first week (16.0\%), and the former was significantly correlated with work hours of the penultimate week (r=0.489, P=.002) Conclusions: Our study identified the existence of recall bias of work hours, the extent to which the recall was biased, and the influence of work hours on recall bias. ",
doi="10.2196/26763",
url="https://www.jmir.org/2021/12/e26763",
url="http://www.ncbi.nlm.nih.gov/pubmed/34951600"
}


@Article{info:doi/10.2196/27096,
author="Heponiemi, Tarja
and Gluschkoff, Kia
and Vehko, Tuulikki
and Kaihlanen, Anu-Marja
and Saranto, Kaija
and Nissinen, Sari
and Nadav, Janna
and Kujala, Sari",
title="Electronic Health Record Implementations and Insufficient Training Endanger Nurses' Well-being: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="23",
volume="23",
number="12",
pages="e27096",
keywords="electronic health records",
keywords="implementation",
keywords="information systems",
keywords="training",
keywords="stress",
keywords="cognitive failures",
keywords="time pressure",
keywords="registered nurses",
abstract="Background: High expectations have been set for the implementations of health information systems (HIS) in health care. However, nurses have been dissatisfied after implementations of HIS. In particular, poorly functioning electronic health records (EHRs) have been found to induce stress and cognitive workload. Moreover, the need to learn new systems may require considerable effort from nurses. Thus, EHR implementations may have an effect on the well-being of nurses. Objective: This study aimed to examine the associations of EHR-to-EHR implementations and the sufficiency of related training with perceived stress related to information systems (SRIS), time pressure, and cognitive failures among registered nurses. Moreover, we examined the moderating effect of the employment sector (hospital, primary care, social services, and others) on these associations. Methods: This study was a cross-sectional survey study of 3610 registered Finnish nurses in 2020. EHR implementation was measured by assessing whether the work unit of each respondent had implemented or will implement a new EHR (1) within the last 6 months, (2) within the last 12 months, (3) in the next 12 months, and (4) at no point within the last 12 months or in the forthcoming 12 months. The associations were examined using analyses of covariance adjusted for age, gender, and employment sector. Results: The highest levels of SRIS (adjusted mean 4.07, SE 0.05) and time pressure (adjusted mean 4.55, SE 0.06) were observed among those who had experienced an EHR implementation within the last 6 months. The lowest levels of SRIS (adjusted mean 3.26, SE 0.04), time pressure (adjusted mean 4.41, SE 0.05), and cognitive failures (adjusted mean 1.84, SE 0.02) were observed among those who did not experience any completed or forthcoming implementations within 12 months. Nurses who perceived that they had received sufficient implementation-related training experienced less SRIS (F1=153.40, P<.001), time pressure (F1=80.95, P<.001), and cognitive failures (F1=34.96, P<.001) than those who had received insufficient training. Recent implementations and insufficient training were especially strongly associated with high levels of SRIS in hospitals. Conclusions: EHR implementations and insufficient training related to these implementations may endanger the well-being of nurses and even lead to errors. Thus, it is extremely important for organizations to offer comprehensive training before, during, and after implementations. Moreover, easy-to-use systems that allow transition periods, a re-engineering approach, and user involvement may be beneficial to nurses in the implementation process. Training and other improvements would be especially important in hospitals. ",
doi="10.2196/27096",
url="https://www.jmir.org/2021/12/e27096",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941546"
}


@Article{info:doi/10.2196/22107,
author="Ebert, Daniel David
and Franke, Marvin
and Zarski, Anna-Carlotta
and Berking, Matthias
and Riper, Heleen
and Cuijpers, Pim
and Funk, Burkhardt
and Lehr, Dirk",
title="Effectiveness and Moderators of an Internet-Based Mobile-Supported Stress Management Intervention as a Universal Prevention Approach: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="22",
volume="23",
number="12",
pages="e22107",
keywords="stress management intervention",
keywords="universal prevention",
keywords="occupational health",
keywords="moderators",
abstract="Background: Emerging evidence indicates the effectiveness of internet-based mobile-supported stress management interventions (iSMIs) in highly stressed employees. It is yet unclear, however, whether iSMIs are also effective without a preselection process in a universal prevention approach, which more closely resembles routine occupational health care. Moreover, evidence for whom iSMIs might be suitable and for whom not is scarce. Objective: The aim of this study was to evaluate the iSMI GET.ON Stress in a universal prevention approach without baseline inclusion criteria and to examine the moderators of the intervention effects. Methods: A total of 396 employees were randomly assigned to the intervention group or the 6-month waiting list control group. The iSMI consisted of 7 sessions and 1 booster session and offered no therapeutic guidance. Self-report data were assessed at baseline, 7 weeks, and at 6 months following randomization. The primary outcome was perceived stress. Several a priori defined moderators were explored as potential effect modifiers. Results: Participants in the intervention group reported significantly lower perceived stress at posttreatment (d=0.71, 95\% CI 0.51-0.91) and at 6-month follow-up (d=0.61, 95\% CI 0.41-0.81) compared to those in the waiting list control group. Significant differences with medium-to-large effect sizes were found for all mental health and most work-related outcomes. Resilience (at 7 weeks, P=.04; at 6 months, P=.01), agreeableness (at 7 weeks, P=.01), psychological strain (at 6 months, P=.04), and self-regulation (at 6 months, P=.04) moderated the intervention effects. Conclusions: This study indicates that iSMIs can be effective in a broad range of employees with no need for preselection to achieve substantial effects. The subgroups that might not profit had extreme values on the respective measures and represented only a very small proportion of the investigated sample, thereby indicating the broad applicability of GET.ON Stress. Trial Registration: German Clinical Trials Register DRKS00005699; https://www.drks.de/DRKS00005699 ",
doi="10.2196/22107",
url="https://www.jmir.org/2021/12/e22107",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941541"
}


@Article{info:doi/10.2196/27521,
author="Mbiine, Ronald
and Nakanwagi, Cephas
and Lekuya, Monka Herve
and Aine, Joan
and Hakim, Kawesi
and Nabunya, Lilian
and Tomusange, Henry",
title="An Early Warning Mobile Health Screening and Risk Scoring App for Preventing In-Hospital Transmission of COVID-19 by Health Care Workers: Development and Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="17",
volume="5",
number="12",
pages="e27521",
keywords="mHealth",
keywords="risk score for Covid-19",
keywords="Africa",
keywords="mobile health",
keywords="digital health",
keywords="pandemic",
keywords="COVID-19",
keywords="COVID",
keywords="screening tool",
keywords="healthcare workers",
keywords="transmission",
keywords="warning system",
abstract="Background: Hospitals have been identified as very high-risk places for COVID-19 transmission between health care workers and patients who do not have COVID-19. Health care workers are the most at-risk population to contract and transmit the infection, especially to already vulnerable patients who do not have COVID-19. In low-income countries, routine testing is not feasible due to the high cost of testing; therefore, presenting the risk of uncontrolled transmission within non--COVID-19 treatment wards. This challenge necessitated the development of an affordable intermediary screening tool that would enable early identification of potentially infected health care workers and for early real time DNA--polymerase chain reaction testing prioritization. This would limit the contact time of potentially infected health care workers with the patients but also enable efficient use of the limited testing kits. Objective: The aims of this study are to describe an early warning in-hospital mobile risk analysis app for screening COVID-19 and to determine the feasibility and user-friendliness of the app among health care workers. Methods: The primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with over 69\% of the health care workers having logged more than 67\% of the required times. Over 93\% of the participants reported that the tool was easy to use. Results: The primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with 69\% of the health care workers (69/100) having logged more than 67\% of the required times. Of the 100 participants, 93 reported that the tool was easy to use. Conclusions: The EWAS mobile app is a feasible and user-friendly daily risk scoring tool for preventing in-hospital transmission of COVID-19. Although it was not designed to be a diagnostic tool but rather a screening tool, there is a need to evaluate its sensitivity in predicting persons likely to have contracted COVID-19. ",
doi="10.2196/27521",
url="https://formative.jmir.org/2021/12/e27521",
url="http://www.ncbi.nlm.nih.gov/pubmed/34793321"
}


@Article{info:doi/10.2196/32165,
author="Goodday, M. Sarah
and Karlin, Emma
and Alfarano, Alexandria
and Brooks, Alexa
and Chapman, Carol
and Desille, Rachelle
and Rangwala, Shazia
and Karlin, R. Daniel
and Emami, Hoora
and Woods, Fugate Nancy
and Boch, Adrien
and Foschini, Luca
and Wildman, Mackenzie
and Cormack, Francesca
and Taptiklis, Nick
and Pratap, Abhishek
and Ghassemi, Marzyeh
and Goldenberg, Anna
and Nagaraj, Sujay
and Walsh, Elaine
and 
and Friend, Stephen",
title="An Alternative to the Light Touch Digital Health Remote Study: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="10",
volume="5",
number="12",
pages="e32165",
keywords="stress",
keywords="wearable",
keywords="digital health",
keywords="frontline",
keywords="COVID-19",
keywords="health care worker",
keywords="alternative",
keywords="design",
keywords="app",
keywords="assessment",
keywords="sensor",
keywords="engagement",
keywords="support",
keywords="knowledge",
abstract="Background: Several app-based studies share similar characteristics of a light touch approach that recruit, enroll, and onboard via a smartphone app and attempt to minimize burden through low-friction active study tasks while emphasizing the collection of passive data with minimal human contact. However, engagement is a common challenge across these studies, reporting low retention and adherence. Objective: This study aims to describe an alternative to a light touch digital health study that involved a participant-centric design including high friction app-based assessments, semicontinuous passive data from wearable sensors, and a digital engagement strategy centered on providing knowledge and support to participants. Methods: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study included US frontline health care workers followed between May and November 2020. The study comprised 3 main components: (1) active and passive assessments of stress and symptoms from a smartphone app, (2) objective measured assessments of acute stress from wearable sensors, and (3) a participant codriven engagement strategy that centered on providing knowledge and support to participants. The daily participant time commitment was an average of 10 to 15 minutes. Retention and adherence are described both quantitatively and qualitatively. Results: A total of 365 participants enrolled and started the study, and 81.0\% (n=297) of them completed the study for a total study duration of 4 months. Average wearable sensor use was 90.6\% days of total study duration. App-based daily, weekly, and every other week surveys were completed on average 69.18\%, 68.37\%, and 72.86\% of the time, respectively. Conclusions: This study found evidence for the feasibility and acceptability of a participant-centric digital health study approach that involved building trust with participants and providing support through regular phone check-ins. In addition to high retention and adherence, the collection of large volumes of objective measured data alongside contextual self-reported subjective data was able to be collected, which is often missing from light touch digital health studies. Trial Registration: ClinicalTrials.gov NCT04713111; https://clinicaltrials.gov/ct2/show/NCT04713111 ",
doi="10.2196/32165",
url="https://formative.jmir.org/2021/12/e32165",
url="http://www.ncbi.nlm.nih.gov/pubmed/34726607"
}


@Article{info:doi/10.2196/31358,
author="Koren, Ainat
and Alam, Ul Mohammad Arif
and Koneru, Sravani
and DeVito, Alexa
and Abdallah, Lisa
and Liu, Benyuan",
title="Nursing Perspectives on the Impacts of COVID-19: Social Media Content Analysis",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="10",
volume="5",
number="12",
pages="e31358",
keywords="mental health",
keywords="information retrieval",
keywords="coronavirus",
keywords="COVID-19",
keywords="nursing",
keywords="nurses",
keywords="health care workers",
keywords="pandemic",
keywords="impact",
keywords="social media analytics",
abstract="Background: Nurses are at the forefront of the COVID-19 pandemic. During the pandemic, nurses have faced an elevated risk of exposure and have experienced the hazards related to a novel virus. While being heralded as lifesaving heroes on the front lines of the pandemic, nurses have experienced more physical, mental, and psychosocial problems as a consequence of the COVID-19 outbreak. Social media discussions by nursing professionals participating in publicly formed Facebook groups constitute a valuable resource that offers longitudinal insights. Objective: This study aimed to explore how COVID-19 impacted nurses through capturing public sentiments expressed by nurses on a social media discussion platform and how these sentiments changed over time. Methods: We collected over 110,993 Facebook discussion posts and comments in an open COVID-19 group for nurses from March 2020 until the end of November 2020. Scraping of deidentified offline HTML tags on social media posts and comments was performed. Using subject-matter expert opinions and social media analytics (ie, topic modeling, information retrieval, and sentiment analysis), we performed a human-in-a-loop analysis of nursing professionals' key perspectives to identify trends of the COVID-19 impact among at-risk nursing communities. We further investigated the key insights of the trends of the nursing professionals' perspectives by detecting temporal changes of comments related to emotional effects, feelings of frustration, impacts of isolation, shortage of safety equipment, and frequency of safety equipment uses. Anonymous quotes were highlighted to add context to the data. Results: We determined that COVID-19 impacted nurses' physical, mental, and psychosocial health as expressed in the form of emotional distress, anger, anxiety, frustration, loneliness, and isolation. Major topics discussed by nurses were related to work during a pandemic, misinformation spread by the media, improper personal protective equipment (PPE), PPE side effects, the effects of testing positive for COVID-19, and lost days of work related to illness. Conclusions: Public Facebook nursing groups are venues for nurses to express their experiences, opinions, and concerns and can offer researchers an important insight into understanding the COVID-19 impact on health care workers. ",
doi="10.2196/31358",
url="https://formative.jmir.org/2021/12/e31358",
url="http://www.ncbi.nlm.nih.gov/pubmed/34623957"
}


@Article{info:doi/10.2196/17314,
author="Eklund, Caroline
and S{\"o}derlund, Anne
and Elfstr{\"o}m, L. Magnus",
title="Evaluation of a Web-Based Stress Management Program for Persons Experiencing Work-Related Stress in Sweden (My Stress Control): Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2021",
month="Dec",
day="9",
volume="8",
number="12",
pages="e17314",
keywords="behavior change",
keywords="behavior medicine",
keywords="internet",
keywords="stress prevention",
abstract="Background: Stress is one of the most common reasons for sick leave. Web-based interventions have the potential to reach an unlimited number of users at a low cost and have been shown to be effective in addressing several health-related problems. Handling stress on an individual level is related to behavior change. To support behavioral changes in stress management, My Stress Control (MSC) was developed. The development of MSC was based on several health psychology theories and models; however, central in the development were Social Cognitive Theory, Theory of Reasoned Action, Theory of Planned Behavior, Transactional Theory of Stress and Coping, and the Transtheoretical Model and Stages of Change. MSC is a fully automated program. The program is tailored to the user's specific needs for stress management and behavior change. Objective: In this study, we aim to conduct a randomized controlled trial to evaluate the extent to which MSC affects perceived stress in persons experiencing work-related stress. Methods: This was a randomized controlled trial with 2 arms. Study participants were recruited by visiting the worksites and workplace meetings. Participants were assigned to the intervention or wait-list group. Web-based questionnaires were used before and after the intervention to collect data. Perceived stress measured using the Perceived Stress Scale-14 was the primary outcome measurement. Analyses were conducted for both between-group and within-group changes. Results: A total of 92 participants were included in this study: 48 (52\%) in the intervention group and 44 (48\%) in the wait-list group. Overall, 25\% (12/48) of participants in the intervention group and 43\% (19/44) of participants in the wait-list group completed the postintervention assessment. There were no significant effects on perceived stress between the intervention and wait-list groups or within the groups. A small effect size (Cohen d=0.25) was found when comparing mean change over time on the primary outcome measure between the intervention and wait-list groups. In addition, a small effect size was found between pre- and postintervention assessments within the intervention group (Cohen d=0.38) as well as within the wait-list group (Cohen d=0.25). Conclusions: The effect of MSC on perceived stress remains uncertain. As adherence was low in the intervention group, elements or features that facilitate adherence and engagement must be further developed before firmer conclusions regarding the effect of MSC can be made. Trial Registration: ClinicalTrials.gov NCT03077568; https://clinicaltrials.gov/ct2/show/NCT03077568 ",
doi="10.2196/17314",
url="https://mental.jmir.org/2021/12/e17314",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889772"
}


@Article{info:doi/10.2196/31574,
author="Edwards, J. Laura
and Fowlkes, L. Ashley
and Wesley, G. Meredith
and Kuntz, L. Jennifer
and Odean, J. Marilyn
and Caban-Martinez, J. Alberto
and Dunnigan, Kayan
and Phillips, L. Andrew
and Grant, Lauren
and Herring, K. Meghan
and Groom, C. Holly
and Respet, Karley
and Beitel, Shawn
and Zunie, Tnelda
and Hegmann, T. Kurt
and Kumar, Archana
and Joseph, Gregory
and Poe, Brandon
and Louzado-Feliciano, Paola
and Smith, E. Michael
and Thiese, S. Matthew
and Schaefer-Solle, Natasha
and Yoo, M. Young
and Silvera, A. Carlos
and Mayo Lamberte, Julie
and Mak, Josephine
and McDonald, Clifford L.
and Stuckey, J. Matthew
and Kutty, Preeta
and Arvay, L. Melissa
and Yoon, K. Sarang
and Tyner, L. Harmony
and Burgess, L. Jefferey
and Hunt, Rentz Danielle
and Meece, Jennifer
and Gaglani, Manjusha
and Naleway, L. Allison
and Thompson, G. Mark",
title="Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER): Protocol for a Multisite Longitudinal Cohort Study",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="3",
volume="10",
number="12",
pages="e31574",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="incidence",
keywords="vaccine effectiveness",
keywords="cohort study",
keywords="health care personnel",
keywords="first responder",
keywords="essential and frontline workers",
abstract="Background: Workers critical to emergency response and continuity of essential services during the COVID-19 pandemic are at a disproportionally high risk of SARS-CoV-2 infection. Prospective cohort studies are needed for enhancing the understanding of the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, identifying risk factors, assessing clinical outcomes, and determining the effectiveness of vaccination. Objective: The Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) prospective cohort study was designed to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, examine the risk factors for infection and clinical spectrum of illness, and assess the effectiveness of vaccination among essential workers. Methods: The RECOVER multisite network was initiated in August 2020 and aims to enroll 3000 health care personnel (HCP), first responders, and other essential and frontline workers (EFWs) at 6 US locations. Data on participant demographics, medical history, and vaccination history are collected at baseline and throughout the study. Active surveillance for the symptoms of COVID-19--like illness (CLI), access of medical care, and symptom duration is performed by text messages, emails, and direct participant or medical record reports. Participants self-collect a mid-turbinate nasal swab weekly, regardless of symptoms, and 2 additional respiratory specimens at the onset of CLI. Blood is collected upon enrollment, every 3 months, approximately 28 days after a reverse transcription polymerase chain reaction (RT-PCR)--confirmed SARS-CoV-2 infection, and 14 to 28 days after a dose of any COVID-19 vaccine. From February 2021, household members of RT-PCR--confirmed participants are self-collecting mid-turbinate nasal swabs daily for 10 days. Results: The study observation period began in August 2020 and is expected to continue through spring 2022. There are 2623 actively enrolled RECOVER participants, including 280 participants who have been found to be positive for SARS-CoV-2 by RT-PCR. Enrollment is ongoing at 3 of the 6 study sites. Conclusions: Data collected through the cohort are expected to provide important public health information for essential workers at high risk for occupational exposure to SARS-CoV-2 and allow early evaluation of COVID-19 vaccine effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/31574 ",
doi="10.2196/31574",
url="https://www.researchprotocols.org/2021/12/e31574",
url="http://www.ncbi.nlm.nih.gov/pubmed/34662287"
}


@Article{info:doi/10.2196/26370,
author="Counson, Isabelle
and Bartholomew, Alexandra
and Crawford, Joanna
and Petrie, Katherine
and Basarkod, Geetanjali
and Moynihan, Victoria
and Pires, Josie
and Cohen, Rachel
and Glozier, Nicholas
and Harvey, Samuel
and Sanatkar, Samineh",
title="Development of the Shift Smartphone App to Support the Emotional Well-Being of Junior Physicians: Design of a Prototype and Results of Usability and Acceptability Testing",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="2",
volume="5",
number="12",
pages="e26370",
keywords="digital mental health",
keywords="mHealth apps",
keywords="help-seeking",
keywords="junior physicians",
keywords="co-design",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: Junior physicians report higher levels of psychological distress than senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health (mHealth) apps may be utilized to help overcome these barriers to assist the emotional well-being of this population and encourage help-seeking. Objective: This study describes the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior physicians to seek information about, and help for, well-being and mental health concerns, which is sensitive to workplace settings. Methods: A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior physicians using the principles of user-centered design. These 4 phases were---needs assessment, on the basis of interviews with 12 junior physicians; prototype development with user experience feedback from 2 junior physicians; evaluation, consisting of a pilot trial with 22 junior physicians to assess the usability and acceptability of the initial prototype; and redesign, including user experience workshops with 51 junior physicians. Results: Qualitative results informed the content and design of Shift to ensure that the app was tailored to junior physicians' needs. The Shift app prototype contained cognitive behavioral, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function that visualized patterns of daily variations in mood and health behaviors. Pilot-testing revealed possible issues with the organization of the app content, which were addressed through a thorough restructuring and redesign of Shift with the help of junior physicians across 3 user experience workshops. Conclusions: This study demonstrates the importance of ongoing end user involvement in the creation of a specialized mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are the first steps in addressing the mental health and support-seeking needs of junior physicians, although further research is required to validate its effectiveness and appropriateness on a larger scale. ",
doi="10.2196/26370",
url="https://formative.jmir.org/2021/12/e26370",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860662"
}


@Article{info:doi/10.2196/30708,
author="Tronco Hern{\'a}ndez, Abigail Yessica
and Parente, Fabio
and Faghy, A. Mark
and Roscoe, P. Clare M.
and Maratos, A. Frances",
title="Influence of the COVID-19 Lockdown on the Physical and Psychosocial Well-being and Work Productivity of Remote Workers: Cross-sectional Correlational Study",
journal="JMIRx Med",
year="2021",
month="Dec",
day="1",
volume="2",
number="4",
pages="e30708",
keywords="COVID-19",
keywords="pandemic",
keywords="remote workers",
keywords="mental health",
keywords="health policy",
keywords="employment",
keywords="policymakers",
keywords="wellbeing",
abstract="Background: Lockdowns imposed during the COVID-19 pandemic have impacted the living and working habits of millions of people, with potentially important implications for their physical, mental, and social well-being. Objective: The primary objective of this study was to investigate the impact of the COVID-19 pandemic on remote workers who were not directly affected by COVID-19. Methods: This was a correlational cross-sectional study (with an additional qualitative component) of 184 remote workers surveyed during the first COVID-19 lockdown in the United Kingdom. Standard measures of mental health (Kessler-6 Distress Scale), productivity (Brief Instrument to Assess Workers' Productivity During a Working Day), and physical activity (International Physical Activity Questionnaire) were used, and respondents were further surveyed on changes to their dietary, exercise, smoking, drinking, and socialization habits to produce a well-being change index. Results: The results revealed associations between sedentary behavior and poorer mental health ($\tau$b=0.14) and between poorer mental health and low work productivity ($\tau$b=--0.39). However, both positive and negative lifestyle changes were reported; a self-reported increase in well-being (with respect to diet, exercise, smoking, alcohol consumption, and socialization) since the start of the pandemic was associated with both better mental health ($\tau$b=--0.14) and better work productivity ($\tau$b=0.14). Of note, among respondents without a mental health diagnosis (137/184, 74.4\%), we observed rates of moderate (76/137, 55.5\%) and severe (17/137, 12.4\%) psychological distress, which were markedly higher than those reported in large prepandemic studies; moreover, 70.1\% (129/184) of our respondents reported more sedentary behavior, 41\% (69/168) increased their alcohol consumption, and 38.6\% (71/184) increased their overall food intake. However, 46\% (75/163), 44.8\% (39/87) and 51.8\% (57/110) of respondents reported spending more time walking and engaging in more moderate and vigorous exercise, respectively. Qualitative analysis revealed many positive adaptations to lockdowns (eg, decreased commuting expenses, flexibility) but also a number of structural obstacles to remote working (eg, lack of support and high expectations from employers, childcare duties). Conclusions: These findings may be of practical importance for policy makers and employers in a world in which work involves long-term remote or hybrid employment arrangements; strategies to promote more sustainable remote working are discussed. ",
doi="10.2196/30708",
url="https://med.jmirx.org/2021/4/e30708",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898665"
}


@Article{info:doi/10.2196/29970,
author="Midorikawa, Haruhiko
and Tachikawa, Hirokazu
and Taguchi, Takaya
and Shiratori, Yuki
and Takahashi, Asumi
and Takahashi, Sho
and Nemoto, Kiyotaka
and Arai, Tetsuaki",
title="Demographics Associated With Stress, Severe Mental Distress, and Anxiety Symptoms During the COVID-19 Pandemic in Japan: Nationwide Cross-sectional Web-Based Survey",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="22",
volume="7",
number="11",
pages="e29970",
keywords="COVID-19",
keywords="mental health",
keywords="stress",
keywords="depression",
keywords="anxiety",
keywords="occupation",
keywords="public health",
keywords="demographic factors",
keywords="epidemiology",
keywords="occupational health",
abstract="Background: With the spread of COVID-19, the deterioration of public mental health has become a major global and social problem. Objective: The purpose of this study was to elucidate the relationship between the 3 mental health problems associated with COVID-19, that is, perceived stress, severe mental distress, and anxiety symptoms, and the various demographic factors, including occupation. Methods: A nationwide web-based questionnaire survey was conducted in Japan from August 4 to 31, 2020. In addition to sociodemographic data, the degrees of perceived stress, severe mental distress, and anxiety symptoms associated with COVID-19 were measured. After performing a descriptive statistical analysis, factors related to stress, severe mental distress, and anxiety symptoms were analyzed using logistic regression analysis. Results: A total of 8203 respondents submitted survey responses, among whom 34.9\% (2861/8203) felt intense stress associated with COVID-19, 17.1\% (1403/8203) were depressed, and 13.5\% (1110/8203) had severe anxiety symptoms. The logistic regression analysis showed that each of the 3 mental health problems were prevalent in females, nonbinary gender, people in their 50s, 60s and older, respondents who visited psychiatrists, and those currently in psychiatric care. Severe mental distress and anxiety symptoms were associated with the number of effective lifestyle coping strategies during the lockdown period. Severe mental distress was only prevalent in teenagers and respondents in their 20s, as students tended to develop  stress and severe mental distress. With regard to occupation, working in nursing care and welfare, education and research, and medical and health sectors was associated with stress; however, working in these occupations was not associated with severe mental distress and anxiety symptoms. Unemployment was associated with severe mental distress and anxiety symptoms. All 3 mental health problems were prevalent in part-time workers and those working in entertainment and arts sectors. Conclusions: Gender, age, occupation, history of psychiatric visits, and stress coping mechanisms were associated with mental health during the COVID-19 pandemic, but their associations with stress, severe mental distress, and anxiety symptoms differed. In addition, the actual state of mental health varied according to the respondents' occupation. It is necessary to consider the impact of the COVID-19 pandemic on mental health not only at the individual level but also at the occupational level. ",
doi="10.2196/29970",
url="https://publichealth.jmir.org/2021/11/e29970",
url="http://www.ncbi.nlm.nih.gov/pubmed/34653018"
}


@Article{info:doi/10.2196/33576,
author="Leal-Neto, Onicio
and Egger, Thomas
and Schlegel, Matthias
and Flury, Domenica
and Sumer, Johannes
and Albrich, Werner
and Babouee Flury, Baharak
and Kuster, Stefan
and Vernazza, Pietro
and Kahlert, Christian
and Kohler, Philipp",
title="Digital SARS-CoV-2 Detection Among Hospital Employees: Participatory Surveillance Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="22",
volume="7",
number="11",
pages="e33576",
keywords="digital epidemiology",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="health care workers",
abstract="Background: The implementation of novel techniques as a complement to traditional disease surveillance systems represents an additional opportunity for rapid analysis. Objective: The objective of this work is to describe a web-based participatory surveillance strategy among health care workers (HCWs) in two Swiss hospitals during the first wave of COVID-19. Methods: A prospective cohort of HCWs was recruited in March 2020 at the Cantonal Hospital of St. Gallen and the Eastern Switzerland Children's Hospital. For data analysis, we used a combination of the following techniques: locally estimated scatterplot smoothing (LOESS) regression, Spearman correlation, anomaly detection, and random forest. Results: From March 23 to August 23, 2020, a total of 127,684 SMS text messages were sent, generating 90,414 valid reports among 1004 participants, achieving a weekly average of 4.5 (SD 1.9) reports per user. The symptom showing the strongest correlation with a positive polymerase chain reaction test result was loss of taste. Symptoms like red eyes or a runny nose were negatively associated with a positive test. The area under the receiver operating characteristic curve showed favorable performance of the classification tree, with an accuracy of 88\% for the training data and 89\% for the test data. Nevertheless, while the prediction matrix showed good specificity (80.0\%), sensitivity was low (10.6\%). Conclusions: Loss of taste was the symptom that was most aligned with COVID-19 activity at the population level. At the individual level---using machine learning--based random forest classification---reporting loss of taste and limb/muscle pain as well as the absence of runny nose and red eyes were the best predictors of COVID-19. ",
doi="10.2196/33576",
url="https://publichealth.jmir.org/2021/11/e33576",
url="http://www.ncbi.nlm.nih.gov/pubmed/34727046"
}


@Article{info:doi/10.2196/33481,
author="Lancioni, E. Giulio
and Singh, N. Nirbhay
and O'Reilly, F. Mark
and Sigafoos, Jeff
and Alberti, Gloria
and Chiariello, Valeria
and Campodonico, Francesca
and Desideri, Lorenzo",
title="Technology-Aided Spatial Cues, Instructions, and Preferred Stimulation for Supporting People With Intellectual and Visual Disabilities in Their Occupational Engagement and Mobility: Usability Study",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Nov",
day="17",
volume="8",
number="4",
pages="e33481",
keywords="technology",
keywords="smartphone",
keywords="motion sensors",
keywords="intellectual disability",
keywords="visual impairments",
keywords="occupational engagement",
keywords="mobility",
keywords="mobile phone",
abstract="Background: Persons with severe or profound intellectual disability and visual impairment tend to be passive and sedentary, and technology-aided intervention may be required to improve their condition without excessive demands on staff time. Objective: This study aims to extend the assessment of technology-aided interventions for supporting functional occupational engagement and mobility in 7 people with intellectual disability and visual impairment and to use a technology system that is simpler and less expensive than those previously used. Methods: The technology system involved a Samsung Galaxy A10, 4 Philips Hue indoor motion sensors, and 4 mini speakers. Within each session, the participants were to collect 18 objects (ie, one at a time) from 3 different areas (stations) located within a large room, bring each of the objects to a central desk, and put away each of those objects there. For each object, the participants received verbal (spatial) cues for guiding them to the area where the object was to be collected, a verbal instruction (ie, request) to take an object, verbal (spatial) cues for guiding them to the central desk, a verbal instruction to put away the object collected, and praise and preferred stimulation. Results: During baseline, the frequency of responses completed correctly (objects collected and put away independently) was 0 or near 0. During the intervention phase (ie, with the support of the technology setup), the frequency increased for all participants, reaching a mean of almost 18 (out of 18 response opportunities) for 6 participants and about 13 for the remaining participant. The mean session duration ranged from 12 to 30 minutes. Conclusions: A program, such as the one used in this study, can be useful in promoting occupational engagement and mobility in persons with intellectual disability and visual impairment. ",
doi="10.2196/33481",
url="https://rehab.jmir.org/2021/4/e33481",
url="http://www.ncbi.nlm.nih.gov/pubmed/34787588"
}


@Article{info:doi/10.2196/32591,
author="Valera, Pamela
and Carmona, David
and Malarkey, Sarah
and Sinangil, Noah
and Owens, Madelyn
and Lefebre, Asia",
title="Exploring Online Health Reviews to Monitor COVID-19 Public Health Responses in Alabama State Department of Corrections: Case Example",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="10",
volume="5",
number="11",
pages="e32591",
keywords="Alabama",
keywords="correctional facilities",
keywords="COVID-19",
keywords="online health reviews",
keywords="review",
keywords="monitoring",
keywords="public health",
keywords="policy",
keywords="response",
keywords="prison",
keywords="United States",
keywords="case study",
keywords="formative",
keywords="feasibility",
keywords="acceptability",
keywords="survey",
abstract="Background: COVID-19, caused by SARS-CoV-2, has devastated incarcerated people throughout the United States. Objective: The purpose of this study was to test the feasibility and acceptability of a COVID-19 Health Review for Correctional Facilities. Methods: The COVID-19 Health Review survey for the Department of Corrections was developed in Qualtrics to assess the following: (1) COVID-19 testing, (2) providing personal protective equipment, (3) vaccination procedures, (4) quarantine procedures, (5) COVID-19 mortality rates for inmates, (6) COVID-19 mortality rates for correctional officers and prison staff, (7) COVID-19 infection rates for inmates, (8) COVID-19 infection rates for correctional officers and prison staff, and (9) uptake of COVID-19 vaccines. The estimated time to review the Alabama State Department of Corrections COVID-19 responses on their website and complete the survey items was 45 minutes to 1 hour. Results: Of the 21 participants who completed the COVID-19 Health Review for Correctional Facilities survey, 48\% (n=10) identified as female, 43\% (n=9) identified as male, and 10\% (n=2) identified as transgender. For race, 29\% (n=6) self-identified as Black or African American, 24\% (n=5) Asian, 24\% (n=5) White, 5\% (n=1) Pacific Islander or Native Hawaiian, and 19\% (n=4) Other. In addition, 5 respondents self-identified as returning citizens. For COVID-19 review questions, the majority concluded that information on personal protective equipment was ``poor'' and ``very poor,'' information on COVID-19 testing was ``fair'' and above, information on COVID-19 death/infection rates between inmates and staff was ``good'' and ``very good,'' and information on vaccinations was ``good'' and ``very good.'' There was a significant difference observed (P=.03) between nonreturning citizens and returning citizens regarding the health grade review with respect to available information on COVID-19 infection rates. Conclusions: COVID-19 health reviews may provide an opportunity for the public to review the COVID-19 responses in correctional settings. ",
doi="10.2196/32591",
url="https://formative.jmir.org/2021/11/e32591",
url="http://www.ncbi.nlm.nih.gov/pubmed/34609313"
}


@Article{info:doi/10.2196/18969,
author="Nwaogu, Mayowa Janet
and Chan, C. Albert P.
and Naslund, A. John
and Hon, H. Carol K.
and Belonwu, Christopher
and Yang, Jackie",
title="Exploring the Barriers to and Motivators for Using Digital Mental Health Interventions Among Construction Personnel in Nigeria: Qualitative Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="9",
volume="5",
number="11",
pages="e18969",
keywords="mental health",
keywords="construction personnel",
keywords="digital technology",
keywords="digital intervention",
keywords="barriers",
keywords="motivators",
keywords="mobile phone",
abstract="Background: Work-related stress in the construction industry increases the prevalence of depression and anxiety among personnel. In low-resource settings such as Nigeria, construction personnel face high demands and severe working conditions but only have a few services to address their mental health needs. With emerging research showing that digital interventions can be used to self-manage mental health across diverse settings, there may be new opportunities to support construction personnel in the construction industry. Objective: This study aims to determine the use of digital interventions for mental health management among construction personnel in Nigeria and to explore the factors that facilitate or impede the use of these interventions. Methods: This qualitative study explored the perspectives of a convenience sample of 62 construction personnel. The data were subjected to inductive content analysis. Results: A total of 6 barrier and 3 motivator themes were identified and categorized into 2 groups. The barrier themes were subcategorized into barriers to adoption and barriers to persistent use, whereas the motivator themes were subcategorized into intrinsic and extrinsic motivators. Lack of awareness and knowledge about the interventions may constitute a barrier to adoption and use. Participants frequently reported concerns regarding their effectiveness and usability. Conclusions: This study provides an understanding of the design needs required to facilitate sustained self-management of mental health based on the experiences and expectations of construction personnel with digital interventions. ",
doi="10.2196/18969",
url="https://formative.jmir.org/2021/11/e18969",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751652"
}


@Article{info:doi/10.2196/31408,
author="Golz, Christoph
and Peter, Anne Karin
and M{\"u}ller, J{\"o}rg Thomas
and Mutschler, Jochen
and Zwakhalen, G. Sandra M.
and Hahn, Sabine",
title="Technostress and Digital Competence Among Health Professionals in Swiss Psychiatric Hospitals: Cross-sectional Study",
journal="JMIR Ment Health",
year="2021",
month="Nov",
day="4",
volume="8",
number="11",
pages="e31408",
keywords="technostress",
keywords="digital competence",
keywords="psychiatry",
keywords="health professionals",
keywords="multiple regression",
abstract="Background: Psychiatric hospitals are becoming increasingly digitized because of the disruptive rise in technical possibilities. This digitization leads to new tasks and demands for health professionals, which can have an impact on technostress. It is unclear whether digital competence reduces technostress and how technostress affects health professionals' mental and physical health. Objective: This study aims to assess the association between digital competence and technostress, considering individual characteristics and the association between technostress and long-term consequences for health professionals. Methods: Cross-sectional data from 3 Swiss psychiatric hospitals were analyzed using multiple linear regression. The dependent variables for the models were digital competence, technostress, and long-term consequences (intention to leave the organization or the profession, burnout symptoms, job satisfaction, general health status, quality of sleep, headaches, and work ability). One model was calculated for each long-term consequence. The mean scores for technostress and digital competence could range between 0 (fully disagree) and 4 (fully agree), where a high value for technostress indicated high technostress and a high value for digital competence indicated high digital competence. Results: The sample comprised 493 health professionals in psychiatric hospitals. They rated their technostress as moderate (mean 1.30, SD 0.55) and their digital competence as high (mean 2.89, SD 0.73). Digital competence was found to be significantly associated with technostress ($\beta$=?.20; P<.001). Among the individual characteristics, age ($\beta$=.004; P=.03) and profession were significantly associated with both digital competence and technostress. Technostress is a relevant predictor of burnout symptoms ($\beta$=10.32; P<.001), job satisfaction ($\beta$=?6.08; P<.001), intention to leave the profession ($\beta$=4.53; P=.002), organization ($\beta$=7.68; P<.001), general health status ($\beta$=?4.47; P<.001), quality of sleep ($\beta$=?5.87; P<.001), headaches ($\beta$=6.58; P<.001), and work ability ($\beta$=?1.40; P<.001). Conclusions: Physicians and nurses who have more interaction with digital technologies rate their technostress higher and their digital competence lower than those in other professions. Health professionals with low interaction with digital technologies appear to overestimate their digital competence. With increasing digitization in psychiatric hospitals, an increase in the relevance of this topic is expected. Educational organizations and psychiatric hospitals should proactively promote the digital competence of health professionals to manage expected disruptive changes. ",
doi="10.2196/31408",
url="https://mental.jmir.org/2021/11/e31408",
url="http://www.ncbi.nlm.nih.gov/pubmed/34734840"
}


@Article{info:doi/10.2196/30757,
author="Kaufmann, G. Peter
and Havens, S. Donna
and Mensinger, L. Janell
and Bradley, K. Patricia
and Brom, M. Heather
and Copel, C. Linda
and Costello, Alexander
and D'Annunzio, Christine
and Dean Durning, Jennifer
and Maldonado, Linda
and Barrow McKenzie, Ann
and Smeltzer, C. Suzanne
and Yost, Jennifer
and ",
title="The COVID-19 Study of Healthcare and Support Personnel (CHAMPS): Protocol for a Longitudinal Observational Study",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="7",
volume="10",
number="10",
pages="e30757",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="stress",
keywords="depression",
keywords="anxiety",
keywords="sleep",
keywords="social support",
keywords="resilience",
keywords="mental health",
keywords="physical health",
abstract="Background: Early in the development of the COVID-19 pandemic, it was evident that health care workers, first responders, and other essential workers would face significant stress and workplace demands related to equipment shortages and rapidly growing infections in the general population. Although the effects of other sources of stress on health have been documented, the effects of these unique conditions of the COVID-19 pandemic on the long-term health and well-being of the health care workforce are not known. Objective: The COVID-19 Study of Healthcare and Support Personnel (CHAMPS) was designed to document early and longitudinal effects of the pandemic on the mental and physical health of essential workers engaged in health care. We will investigate mediators and moderators of these effects and evaluate the influence of exposure to stress, including morbidity and mortality, over time. We will also examine the effect of protective factors and resilience on health outcomes. Methods: The study cohort is a convenience sample recruited nationally through communities, professional organizations, networks, social media, and snowball sampling. Recruitment took place for 13 months to obtain an estimated sample of 2762 adults who provided self-reported information administered on the web through structured questionnaires about their work environment, mental and physical health, and psychosocial factors. Follow-up questionnaires will be administered after 6 months and annually thereafter to ascertain changes in health, well-being, and lifestyle. Participants who consented to be recontacted form the longitudinal cohort and the CHAMPS Registry may be contacted to ascertain their interest in ancillary studies for which they may be eligible. Results: The study was approved by the Institutional Review Board and launched in May 2020, with grants from Travere Therapeutics Inc, McKesson Corporation, anonymous donors, and internal funding from the M. Louise Fitzpatrick College of Nursing at Villanova University.  Recruitment ended in June 2021 after enrolling 2762 participants, 1534 of whom agreed to participate in the longitudinal study and the registry as well as to be contacted about eligibility for future studies. Conclusions: The CHAMPS Study and Registry will enable the acquisition of detailed data on the effects of extended psychosocial and workplace stress on morbidity and mortality and serve as a platform for ancillary studies related to the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04370821; https://clinicaltrials.gov/ct2/show/NCT04370821 International Registered Report Identifier (IRRID): DERR1-10.2196/30757 ",
doi="10.2196/30757",
url="https://www.researchprotocols.org/2021/10/e30757",
url="http://www.ncbi.nlm.nih.gov/pubmed/34582354"
}


@Article{info:doi/10.2196/28731,
author="de Vries, Herman
and Kamphuis, Wim
and Oldenhuis, Hilbrand
and van der Schans, Cees
and Sanderman, Robbert",
title="Moderation of the Stressor-Strain Process in Interns by Heart Rate Variability Measured With a Wearable and Smartphone App: Within-Subject Design Using Continuous Monitoring",
journal="JMIR Cardio",
year="2021",
month="Oct",
day="4",
volume="5",
number="2",
pages="e28731",
keywords="stress",
keywords="strain",
keywords="burnout",
keywords="resilience",
keywords="heart rate variability",
keywords="sleep",
keywords="wearables",
keywords="digital health",
keywords="sensors",
keywords="ecological momentary assessment",
keywords="mobile phone",
abstract="Background: The emergence of smartphones and wearable sensor technologies enables easy and unobtrusive monitoring of physiological and psychological data related to an individual's resilience. Heart rate variability (HRV) is a promising biomarker for resilience based on between-subject population studies, but observational studies that apply a within-subject design and use wearable sensors in order to observe HRV in a naturalistic real-life context are needed. Objective: This study aims to explore whether resting HRV and total sleep time (TST) are indicative and predictive of the within-day accumulation of the negative consequences of stress and mental exhaustion. The tested hypotheses are that demands are positively associated with stress and resting HRV buffers against this association, stress is positively associated with mental exhaustion and resting HRV buffers against this association, stress negatively impacts subsequent-night TST, and previous-evening mental exhaustion negatively impacts resting HRV, while previous-night TST buffers against this association. Methods: In total, 26 interns used consumer-available wearables (Fitbit Charge 2 and Polar H7), a consumer-available smartphone app (Elite HRV), and an ecological momentary assessment smartphone app to collect resilience-related data on resting HRV, TST, and perceived demands, stress, and mental exhaustion on a daily basis for 15 weeks. Results: Multiple linear regression analysis of within-subject standardized data collected on 2379 unique person-days showed that having a high resting HRV buffered against the positive association between demands and stress (hypothesis 1) and between stress and mental exhaustion (hypothesis 2). Stress did not affect TST (hypothesis 3). Finally, mental exhaustion negatively predicted resting HRV in the subsequent morning but TST did not buffer against this (hypothesis 4). Conclusions: To our knowledge, this study provides first evidence that having a low within-subject resting HRV may be both indicative and predictive of the short-term accumulation of the negative effects of stress and mental exhaustion, potentially forming a negative feedback loop. If these findings can be replicated and expanded upon in future studies, they may contribute to the development of automated resilience interventions that monitor daily resting HRV and aim to provide users with an early warning signal when a negative feedback loop forms, to prevent the negative impact of stress on long-term health outcomes. ",
doi="10.2196/28731",
url="https://cardio.jmir.org/2021/2/e28731",
url="http://www.ncbi.nlm.nih.gov/pubmed/34319877"
}


@Article{info:doi/10.2196/30305,
author="Kawakami, Norito
and Imamura, Kotaro
and Watanabe, Kazuhiro
and Sekiya, Yuki
and Sasaki, Natsu
and Sato, Nana
and ",
title="Effectiveness of an Internet-Based Machine-Guided Stress Management Program Based on Cognitive Behavioral Therapy for Improving Depression Among Workers: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="29",
volume="10",
number="9",
pages="e30305",
keywords="deep learning",
keywords="unguided intervention",
keywords="universal prevention",
keywords="workplace",
keywords="depression",
keywords="machine learning",
abstract="Background: The effect of an unguided internet-based cognitive behavioral therapy (iCBT) stress management program on depression may be enhanced by applying artificial intelligence (AI) technologies to guide participants adopting the program. Objective: The aim of this study is to describe a research protocol to investigate the effect of a newly developed iCBT stress management program adopting AI technologies on improving depression among healthy workers during the COVID-19 pandemic. Methods: This study is a two-arm, parallel, randomized controlled trial. Participants (N=1400) will be recruited, and those who meet the inclusion criteria will be randomly allocated to the intervention or control (treatment as usual) group. A 6-week, six-module, internet-based stress management program, SMART-CBT, has been developed that includes machine-guided exercises to help participants acquire CBT skills, and it applies machine learning and deep learning technologies. The intervention group will participate in the program for 10 weeks. The primary outcome, depression, will be measured using the Beck Depression Inventory II at baseline and 3- and 6-month follow-ups. A mixed model repeated measures analysis will be used to test the intervention effect (group {\texttimes} time interactions) in the total sample (universal prevention) on an intention-to-treat basis. Results: The study was at the stage of recruitment of participants at the time of submission. The data analysis related to the primary outcome will start in January 2022, and the results might be published in 2022 or 2023. Conclusions: This is the first study to investigate the effectiveness of a fully automated machine-guided iCBT program for improving subthreshold depression among workers using a randomized controlled trial design. The study will explore the potential of a machine-guided stress management program that can be disseminated online to a large number of workers with minimal cost in the post--COVID-19 era. Trial Registration: UMIN Clinical Trials Registry?UMIN-CTR) UMIN000043897; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000050125 International Registered Report Identifier (IRRID): PRR1-10.2196/30305 ",
doi="10.2196/30305",
url="https://www.researchprotocols.org/2021/9/e30305",
url="http://www.ncbi.nlm.nih.gov/pubmed/34460414"
}


@Article{info:doi/10.2196/32663,
author="Liu, W. Jenny J.
and Nazarov, Anthony
and Plouffe, A. Rachel
and Forchuk, A. Callista
and Deda, Erisa
and Gargala, Dominic
and Le, Tri
and Bourret-Gheysen, Jesse
and Soares, Vanessa
and Nouri, S. Maede
and Hosseiny, Fardous
and Smith, Patrick
and Roth, Maya
and MacDougall, G. Arlene
and Marlborough, Michelle
and Jetly, Rakesh
and Heber, Alexandra
and Albuquerque, Joy
and Lanius, Ruth
and Balderson, Ken
and Dupuis, Gabrielle
and Mehta, Viraj
and Richardson, Don J.",
title="Exploring the Well-being of Health Care Workers During the COVID-19 Pandemic: Protocol for a Prospective Longitudinal Study",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="27",
volume="10",
number="9",
pages="e32663",
keywords="COVID-19",
keywords="health care worker",
keywords="pandemic",
keywords="mental health",
keywords="wellbeing",
keywords="survey",
keywords="design",
keywords="longitudinal",
keywords="prospective",
keywords="protocol",
keywords="challenge",
keywords="impact",
keywords="distress",
keywords="perception",
abstract="Background: Health care workers (HCWs) have experienced several stressors associated with the COVID-19 pandemic. Structural stressors, including extended work hours, redeployment, and changes in organizational mandates, often intersect with interpersonal and personal stressors, such as caring for those with COVID-19 infections; worrying about infection of self, family, and loved ones; working despite shortages of personal protective equipment; and encountering various difficult moral-ethical dilemmas. Objective: The paper describes the protocol for a longitudinal study seeking to capture the unique experiences, challenges, and changes faced by HCWs during the COVID-19 pandemic. The study seeks to explore the impact of COVID-19 on the mental well-being of HCWs with a particular focus on moral distress, perceptions of and satisfaction with delivery of care, and how changes in work structure are tolerated among HCWs providing clinical services. Methods: A prospective longitudinal design is employed to assess HCWs' experiences across domains of mental health (depression, anxiety, posttraumatic stress, and well-being), moral distress and moral reasoning, work-related changes and telehealth, organizational responses to COVID-19 concerns, and experiences with COVID-19 infections to self and to others. We recruited HCWs from across Canada through convenience snowball sampling to participate in either a short-form or long-form web-based survey at baseline. Respondents to the baseline survey are invited to complete a follow-up survey every 3 months, for a total of 18 months. Results: A total of 1926 participants completed baseline surveys between June 26 and December 31, 2020, and 1859 participants provided their emails to contact them to participate in follow-up surveys. As of July 2021, data collection is ongoing, with participants nearing the 6- or 9-month follow-up periods depending on their initial time of self-enrollment. Conclusions: This protocol describes a study that will provide unique insights into the immediate and longitudinal impact of the COVID-19 pandemic on the dimensions of mental health, moral distress, health care delivery, and workplace environment of HCWs. The feasibility and acceptability of implementing a short-form and long-form survey on participant engagement and data retention will also be discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/32663 ",
doi="10.2196/32663",
url="https://www.researchprotocols.org/2021/9/e32663",
url="http://www.ncbi.nlm.nih.gov/pubmed/34477557"
}


@Article{info:doi/10.2196/27535,
author="Anan, Tomomi
and Kajiki, Shigeyuki
and Oka, Hiroyuki
and Fujii, Tomoko
and Kawamata, Kayo
and Mori, Koji
and Matsudaira, Ko",
title="Effects of an Artificial Intelligence--Assisted Health Program on Workers With Neck/Shoulder Pain/Stiffness and Low Back Pain: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Sep",
day="24",
volume="9",
number="9",
pages="e27535",
keywords="neck pain",
keywords="shoulder pain",
keywords="shoulder stiffness",
keywords="low back pain",
keywords="musculoskeletal symptoms",
keywords="digital intervention",
keywords="mobile app",
keywords="mHealth",
keywords="eHealth",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Musculoskeletal symptoms such as neck and shoulder pain/stiffness and low back pain are common health problems in the working population. They are the leading causes of presenteeism (employees being physically present at work but unable to be fully engaged). Recently, digital interventions have begun to be used to manage health but their effectiveness has not yet been fully verified, and adherence to such programs is always a problem. Objective: This study aimed to evaluate the improvements in musculoskeletal symptoms in workers with neck/shoulder stiffness/pain and low back pain after the use of an exercise-based artificial intelligence (AI)--assisted interactive health promotion system that operates through a mobile messaging app (the AI-assisted health program). We expected that this program would support participants' adherence to exercises. Methods: We conducted a two-armed, randomized, controlled, and unblinded trial in workers with either neck/shoulder stiffness/pain or low back pain or both. We recruited participants with these symptoms through email notifications. The intervention group received the AI-assisted health program, in which the chatbot sent messages to users with the exercise instructions at a fixed time every day through the smartphone's chatting app (LINE) for 12 weeks. The program was fully automated. The control group continued with their usual care routines. We assessed the subjective severity of the neck and shoulder pain/stiffness and low back pain of the participants by using a scoring scale of 1 to 5 for both the intervention group and the control group at baseline and after 12 weeks of intervention by using a web-based form. We used a logistic regression model to calculate the odds ratios (ORs) of the intervention group to achieve to reduce pain scores with those of the control group, and the ORs of the subjective assessment of the improvement of the symptoms compared to the intervention and control groups, which were performed using Stata software (version 16, StataCorp LLC). Results: We analyzed 48 participants in the intervention group and 46 participants in the control group. The adherence rate was 92\% (44/48) during the intervention. The participants in the intervention group showed significant improvements in the severity of the neck/shoulder pain/stiffness and low back pain compared to those in the control group (OR 6.36, 95\% CI 2.57-15.73; P<.001). Based on the subjective assessment of the improvement of the pain/stiffness at 12 weeks, 36 (75\%) out of 48 participants in the intervention group and 3 (7\%) out of 46 participants in the control group showed improvements (improved, slightly improved) (OR 43.00, 95\% CI 11.25-164.28; P<.001). Conclusions: This study shows that the short exercises provided by the AI-assisted health program improved both neck/shoulder pain/stiffness and low back pain in 12 weeks. Further studies are needed to identify the elements contributing to the successful outcome of the AI-assisted health program. Trial Registration: University hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) 000033894; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000038307. ",
doi="10.2196/27535",
url="https://mhealth.jmir.org/2021/9/e27535",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559054"
}


@Article{info:doi/10.2196/31637,
author="Hashiguchi, Nobuki
and Cao, Jianfei
and Lim, Yeongjoo
and Kuroishi, Shinichi
and Miyazaki, Yasuhiro
and Kitahara, Shigeo
and Sengoku, Shintaro
and Matsubayashi, Katsushi
and Kodama, Kota",
title="Psychological Effects of Heart Rate and Physical Vibration on the Operation of Construction Machines: Experimental Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Sep",
day="15",
volume="9",
number="9",
pages="e31637",
keywords="heart rate variability",
keywords="complexity",
keywords="vital signs",
keywords="vibration at work",
keywords="stress",
keywords="wearable technology",
keywords="remote operation",
keywords="monitoring",
abstract="Background: A construction method has emerged in which a camera is installed around a construction machine, and the operator remotely controls the machine while synchronizing the vibration of the machine with the images seen from the operator's seat using virtual reality (VR) technology. Indices related to changes in heart rate (HR) and physical vibration, such as heart rate variability (HRV) and multiscale entropy (MSE), can then be measured among the operators. As these indices are quantitative measures of autonomic regulation in the cardiovascular system, they can provide a useful means of assessing operational stress. Objective: In this study, we aimed to evaluate changes in HR and body vibration of machine operators and investigate appropriate methods of machine operation while considering the psychological load. Methods: We enrolled 9 remote operators (18-50 years old) in the experiment, which involved 42 measurements. A construction machine was driven on a test course simulating a construction site, and three patterns of operation---riding operation, remote operation using monitor images, and VR operation combining monitor images and machine vibration---were compared. The heartbeat, body vibration, and driving time of the participants were measured using sensing wear made of a woven film-like conductive material and a three-axis acceleration measurement device (WHS-2). We used HRV analysis in the time and frequency domains, MSE analysis as a measure of the complexity of heart rate changes, and the ISO (International Standards Organization) 2631 vibration index. Multiple regression analysis was conducted to model the relationship among the low frequency (LF)/high frequency (HF) HRV, MSE, vibration index, and driving time of construction equipment. Efficiency in driving time was investigated with a focus on stress reduction. Results: Multiple comparisons conducted via the Bonferroni test and Kruskal-Wallis test showed statistically significant differences (P=.05) in HRV-LF/HF, the vibration index, weighted acceleration, motion sickness dose value (MSDVz), and the driving time among the three operation patterns. The riding operation was found to reduce the driving time of the machine, but the operation stress was the highest in this case; operation based on the monitor image was found to have the lowest operation stress but the longest operation time. Multiple regression analysis showed that the explanatory variables (LH/HF), RR interval, and vibration index (MSDVz by vertical oscillation at 0.5-5 Hz) had a negative effect on the driving time (adjusted coefficient of determination R2=0.449). Conclusions: A new method was developed to calculate the appropriate operating time by considering operational stress and suppressing the physical vibration within an acceptable range. By focusing on the relationship between psychological load and physical vibration, which has not been explored in previous studies, the relationship of these variables with the driving time of construction machines was clarified. ",
doi="10.2196/31637",
url="https://mhealth.jmir.org/2021/9/e31637",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524105"
}


@Article{info:doi/10.2196/31211,
author="Fung, Po-Lun Kenneth
and Vahabi, Mandana
and Moosapoor, Masoomeh
and Akbarian, Abdolreza
and Jing-Wen Liu, Jenny
and Wong, Pui-Hing Josephine",
title="Implementation of an Internet-Based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada: Protocol",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="13",
volume="10",
number="9",
pages="e31211",
keywords="migrant live-in caregiver",
keywords="women",
keywords="mental health",
keywords="acceptance commitment therapy",
keywords="resiliency",
keywords="empowerment",
abstract="Background: Psychological distress, isolation, feelings of powerlessness, and limited social support are realities faced by temporary migrant live-in caregivers in Canada. Furthermore, they experience multiple barriers in accessing mental health services due to their long work hours, limited knowledge of health resources, precarious employment, and immigration status. Objective: The Women Empowerment - Caregiver Acceptance \& Resilience E-Learning (WE2CARE) project is a pilot intervention research project that aims to promote the mental well-being and resiliency of migrant live-in caregivers. The objectives include exploring the effectiveness of this program in achieving the following: (1) reducing psychological distress (depression, anxiety, and stress); (2) promoting committed actions of self-care; and (3) building mutual support social networks. Further, participants' satisfaction with the intervention and their perceived barriers to and facilitators of practicing the self-care strategies embedded in WE2CARE will be examined. Methods: A total of 36 live-in caregivers residing in the Greater Toronto Area will be recruited and randomly assigned to either the intervention or waitlist control group. The intervention group will receive a 6-week web-based psychosocial intervention that will be based on Acceptance and Commitment Therapy (ACT). Standardized self-reported surveys will be administered online preintervention, postintervention, and at 6 weeks postintervention to assess mental distress (Depression, Anxiety and Stress Scale), psychological flexibility (Acceptance and Action Questionnaire), mindfulness (Cognitive and Affective Mindfulness Scale -- Revised), and resilience (Multi-System Model of Resilience Inventory). In addition, two focus groups will be held with a subset of participants to explore their feedback on the utility of the WE2CARE program. Results: WE2CARE was funded in January 2019 for a year. The protocol was approved by the research ethics boards of Ryerson University (REB 2019-036) and the University of Toronto (RIS37623) in February and May 2019, respectively. Data collection started upon ethics approval and was completed by May 2020. A total of 29 caregivers completed the study and 20 participated in the focus groups. Data analyses are in progress and results will be published in 2021. Conclusions: WE2CARE could be a promising approach to reducing stress, promoting resilience, and providing a virtual space for peer emotional support and collaborative learning among socially isolated and marginalized women. The results of this pilot study will inform the adaptation of an ACT-based psychological intervention for online delivery and determine its utility in promoting mental health among disadvantaged and vulnerable populations. International Registered Report Identifier (IRRID): DERR1-10.2196/31211 ",
doi="10.2196/31211",
url="https://www.researchprotocols.org/2021/9/e31211",
url="http://www.ncbi.nlm.nih.gov/pubmed/34515642"
}


@Article{info:doi/10.2196/28075,
author="Swanston, Emma
and Pulman, Andy
and Dogan, Huseyin
and Murphy, Jane
and Bitters, Fiona",
title="Scoping the Need for a Tailored mHealth App to Improve Health and Well-being Behavioral Transformation in the Police: Exploring the Views of UK Police Workers via Web-Based Surveys and Client Meetings",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="31",
volume="5",
number="8",
pages="e28075",
keywords="nutrition",
keywords="food",
keywords="behavior change",
keywords="mobile health",
keywords="police",
keywords="lifestyle management",
keywords="well-being",
keywords="mobile phone",
abstract="Background: Police officers often work long, unsocial hours in a highly pressurized environment and may experience difficulties in managing their health and well-being. Their jobs can be highly stressful and feature unusual working hours and multiple shift patterns. When considering the policing environment of 2021, many roles that were previously the domain of warranted officers are now being carried out by nonwarranted police staff equivalents. These police staff roles are relatively new to policing but put staff under some of the same stresses as police officers. A UK police force requested help to investigate technologies that could be used to improve health and well-being and research how these technologies could be used to measure and track health behavior change. Objective: Historical research studies need to be appraised in light of this new policing environment, and new research also needs to include this shift in dynamics when considering aspects of policing, including their health and well-being. This study explores police officer and staff attitudes toward and their use of existing health-related technology, highlights existing practices, and gathers views about how technology could be used more effectively. Methods: A web-based survey was completed by police officers and staff (N=213) during the initial period of the UK lockdown in 2020. The survey was designed to find the solutions that participants used outside of those supplied by their employer, identify issues or problems, and find what they would like a hypothetical app to focus on. Additional requirements data were captured through client meetings, including discussions concerning previously attempted solutions and those currently in place. Thematic analysis was undertaken to identify the key themes. Results: Attitudes toward and uses of existing health-related technology were captured, and existing practices were highlighted. Participants identified a need for an app to consider that a user was on shift---an important point, as many issues and problems with elements of their health and well-being involved shift work. Data also highlighted that a multifunctional tool would be more beneficial to participants than focusing on just 1 element. The key features and four domains were identified for app coverage. The prioritized order of importance of the four domains was activity, food and diet, sleep, and fluid intake. Conclusions: For police officers and staff, research data suggest that there is a previously unidentified requirement for a mobile app that could provide an easily accessible platform for them to use, regardless of the current location; one that could provide guidelines on diet, lifestyle habits, and health behavior to help the user make informed decisions to assist in personalized behavior change. Notably, one which is multifunctional and which also aligns effectively with the irregular shift patterns of its users. ",
doi="10.2196/28075",
url="https://formative.jmir.org/2021/8/e28075",
url="http://www.ncbi.nlm.nih.gov/pubmed/34463625"
}


@Article{info:doi/10.2196/29582,
author="Kim, Jin Yun
and Qian, Linchao
and Aslam, Shahzad Muhammad",
title="Cyberbullying Among Traditional and Complementary Medicine Practitioners in the Workplace: Protocol for a Cross-sectional Descriptive Study",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="12",
volume="10",
number="8",
pages="e29582",
keywords="cyberbullying",
keywords="traditional medicine",
keywords="workplace",
keywords="practitioners",
keywords="medical professional",
abstract="Background: Cyberbullying is becoming prevalent among health care professionals and may cause a variety of mental health issues. Traditional and complementary medicine practitioners remain an important pillar of the health care system in Malaysia. Objective: This paper presents a study protocol for an online survey (Cyberbullying Among Traditional and Complementary Medicine Practitioner [TCMPs]) that will collect the first nationwide representative data on cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia. The objectives of the survey are to (1) evaluate the cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia, (2) identify sociodemographic and social factors related to cyberbullying, and (3) evaluate the association between cyberbullying behavior, sociodemographic, and social factors. Methods: A snowball sampling strategy will be applied. Traditional and complementary medicine practitioners who are permanent Malaysian residents will be randomly selected and invited to participate in the survey (N=1023). Cyberbullying behavior will be measured using the Cyberbullying Behavior Questionnaire (CBQ). Data on the following items will be collected: work-related bullying, person-related bullying, aggressively worded messages, distortion of messages, sending offensive photos/videos, hacking computers or sending a virus or rude message, and threatening messages about personal life or family members. We will also collect data on participants' sociodemographic characteristics, social factors, and substance abuse behavior. Results: This cross-sectional descriptive study was registered with Research Registry (Unique Identifying Number 6216; November 05, 2020). This research work (substudy) is planned under a phase 1 study approved by the Research Management Centre, Xiamen University Malaysia. This substudy has been approved by the Research Ethics Committee of Xiamen University Malaysia (REC-2011.01). The cross-sectional survey will be conducted from July 01, 2021, to June 30, 2022. Data preparation and statistical analyses are planned from January 2022 onward. Conclusions: The current research can contribute to identify the prevalence of workplace cyberbullying among Malaysian traditional and complementary medicine practitioners. The results will help government stakeholders, health professionals, and education professionals to understand the psychological well-being of Malaysian traditional and complementary medicine practitioners. Trial Registration: Research Registry Unique Identifying Number 6216; https://tinyurl.com/3rsmxs7u International Registered Report Identifier (IRRID): PRR1-10.2196/29582 ",
doi="10.2196/29582",
url="https://www.researchprotocols.org/2021/8/e29582",
url="http://www.ncbi.nlm.nih.gov/pubmed/34387559"
}


@Article{info:doi/10.2196/29184,
author="Park, Sang Hyun
and Kim, Il Kwang
and Chung, Ho-Young
and Jeong, Sungmoon
and Soh, Young Jae
and Hyun, Ho Young
and Kim, Sun Hwa",
title="A Worker-Centered Personal Health Record App for Workplace Health Promotion Using National Health Care Data Sets: Design and Development Study",
journal="JMIR Med Inform",
year="2021",
month="Aug",
day="4",
volume="9",
number="8",
pages="e29184",
keywords="personal health record app",
keywords="workplace health promotion",
keywords="Fast Healthcare Interoperability Resources",
keywords="national health care data set",
keywords="human-centered design",
abstract="Background: Personal health record (PHR) technology can be used to support workplace health promotion, and prevent social and economic losses related to workers' health management. PHR services can not only ensure interoperability, security, privacy, and data quality, but also consider the user's perspective in their design. Objective: Using Fast Healthcare Interoperability Resources (FHIR) and national health care data sets, this study aimed to design and develop an app for providing worker-centered, interconnected PHR services. Methods: This study considered the user's perspective, using the human-centered design (HCD) methodology, to develop a PHR app suitable for occupational health. We developed a prototype after analyzing quantitative and qualitative data collected from workers and a health care professional group, after which we performed a usability evaluation. We structured workers' PHR items based on the analyzed data, and ensured structural and semantic interoperability using FHIR, Systematized Nomenclature of Medicine--Clinical Terms (SNOMED-CT), and Logical Observation Identifiers Names and Codes (LOINC). This study integrated workers' health information scattered across different Korean institutions through an interface method, and workers' PHRs were managed through a cloud server, using Azure API for FHIR. Results: In total, 562 workers from industrial parks participated in the quantitative study. The preferred data items for PHR were medication, number of steps walked, diet, blood pressure, weight, and blood glucose. The preferred features were ability to access medical checkup results, health information content provision, consultation record inquiry, and teleconsultation. The worker-centered PHR app collected data on, among others, life logs, vital signs, and medical checkup results; offered health care services such as reservation and teleconsultation; and provided occupational safety and health information through material safety data sheet search and health questionnaires. The app reflected improvements in user convenience and app usability proposed by 19 participants (7 health care professionals and 12 end users) in the usability evaluation. The After-Scenario Questionnaire (ASQ) was evaluated with a mean score of 5.90 (SD 0.34) out of 7, and the System Usability Scale (SUS) was evaluated a mean score of 88.7 (SD 4.83) out of 100. Conclusions: The worker-centered PHR app integrates workers' health information from different institutions and provides a variety of health care services from linked institutions through workers' shared PHR. This app is expected to increase workers' autonomy over their health information and support medical personnel's decision making regarding workers' health in the workplace. Particularly, the app will provide solutions for current major PHR challenges, and its design, which considers the user's perspective, satisfies the prerequisites for its utilization in occupational health. ",
doi="10.2196/29184",
url="https://medinform.jmir.org/2021/8/e29184",
url="http://www.ncbi.nlm.nih.gov/pubmed/34346894"
}


@Article{info:doi/10.2196/29126,
author="Kremer, Lisanne
and Lipprandt, Myriam
and R{\"o}hrig, Rainer
and Breil, Bernhard",
title="Examining the Mental Workload Associated With Digital Health Technologies in Health Care: Protocol for a Systematic Review Focusing on Assessment Methods",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="3",
volume="10",
number="8",
pages="e29126",
keywords="mental workload",
keywords="cognitive load",
keywords="assessment",
keywords="healthcare workers",
keywords="health information system",
keywords="digital health technology",
keywords="health care professionals",
keywords="stress",
keywords="eyetracking",
abstract="Background: The workload in health care is high; physicians and nurses report high stress levels due to a demanding environment where they often have to perform multiple tasks simultaneously. As a result, mental health issues among health care professionals (HCPs) are on the rise and the prevalence of errors in their daily tasks could increase. Processes of demographic change are partly responsible for even higher stress levels among HCPs. The digitization of patient care is intended to counteract these processes. However, it remains unclear whether these health information systems (HIS) and digital health technologies (DHT) support the HCPs and relieve stress, or if they represent a further burden. The mental construct that describes this burden of technologies is mental workload (MWL). Work in the clinic can be viewed as working in safety-critical environments. Particularly in this sensitive setting, the measurement methods of MWL are relevant, mainly due to their strongly differing levels of intrusiveness and sensitivity. The method of eye tracking could be a useful way to measure MWL directly in the field. Objective: The systematic review aims to address the following questions: (1) In which manner do DHT contribute to the overall MWL of HCPs? (2) Can we observe a direct or indirect effect of DHT on MWL? (3) Which aspects or factors of DHT contribute to an increase in MWL? (4) Which methods/assessments are applied to measure MWL related to HIS/DHT? (5) What role does eye tracking/pupillometry play in the context of measuring MWL? (6) Which outcomes are being assessed via eye tracking? Methods: Following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement, we will conduct a systematic review. Based on the research questions, we define keywords that we then combine in search terms. The review follows the following steps: literature search, article selection, data extraction, risk of bias assessment, data analysis, and data synthesis. Results: We expect results as well as a finalization of the review in the summer of 2021. Conclusions: This review will evaluate the impact of DHT on the MWL of HCPs. In addition, assessment methods of MWL in the context of digital technologies will be systematically analyzed. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021233271; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?ID=CRD42021233271 International Registered Report Identifier (IRRID): DERR1-10.2196/29126 ",
doi="10.2196/29126",
url="https://www.researchprotocols.org/2021/8/e29126",
url="http://www.ncbi.nlm.nih.gov/pubmed/34342590"
}


@Article{info:doi/10.2196/30845,
author="Alavi, Nazanin
and Stephenson, Callum
and Omrani, Mohsen
and Gerritsen, Cory
and Martin, S. Michael
and Knyahnytskyi, Alex
and Zhu, Yiran
and Kumar, Anchan
and Jagayat, Jasleen
and Shirazi, Amirhossein
and Moghimi, Elnaz
and Patel, Charmy
and Knyahnytska, Yuliya
and Simpson, F. Alexander I.
and Zaheer, Juveria
and Andersen, Judith
and Munshi, Alpna
and Groll, Dianne",
title="Delivering an Online Cognitive Behavioral Therapy Program to Address Mental Health Challenges Faced by Correctional Workers and Other Public Safety Personnel: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="22",
volume="10",
number="7",
pages="e30845",
keywords="mental health",
keywords="correctional workers",
keywords="public safety personnel",
keywords="depression",
keywords="anxiety",
keywords="psychotherapy",
keywords="cognitive behavioral therapy",
keywords="online",
keywords="internet",
keywords="treatment",
abstract="Background: Public safety personnel have regular and often intense exposure to potentially traumatic events at work, especially workplace violence in the case of correctional workers. Subsequently, correctional workers are at higher risk of developing mental health problems such as posttraumatic stress disorder. Public safety personnel are up to 4 times more likely to experience suicidal ideation, suicidal attempts, and death by suicide compared to the general population. Despite this high prevalence, help-seeking behaviors from public safety personnel are low due to stigma and irregular work hours limiting access to care. Innovative treatments are needed to address these challenges. Objective: This study will investigate the efficacy of an electronically delivered cognitive behavioral therapy (e-CBT) program tailored to correctional workers' mental health problems. Methods: This study is composed of 4 phases. In phase 1, we will interview correctional workers individually and in focus groups to identify personal, social, and cultural factors affecting their mental health and barriers to care. Phase 2 will use the information gathered from the interviews to develop gender- and diagnosis-specific e-CBT modules. These will be presented to a new group of participants who will provide further feedback on their usability and accessibility. In phase 3, we will randomly assign participants to either an e-CBT or treatment as usual arm. The program will be evaluated with validated symptomatology questionnaires and interviews. Phase 4 will use this additional information to fine-tune the e-CBT modules for a larger-scale randomized controlled trial design comparing the e-CBT program to in-person CBT. All e-CBT modules will be delivered through a secure online platform. Results: The study received ethics approval in December 2020, and participant recruitment began in March 2021. Participant recruitment has been conducted through targeted advertisements and physician referrals. To date, there have been 15 participants recruited for Phase 1, and it is expected to conclude in July 2021, with phase 2 beginning in September 2021. Complete data collection and analysis from all phases are expected to conclude by July 2023. Linear and binomial regression (for continuous and categorical outcomes, respectively) will be conducted along with interpretive qualitative methods. Conclusions: If proven efficacious and feasible, this e-CBT program can provide a high-quality and clinically validated resource to address the mental health problems of correctional workers. Additionally, findings can contribute to the development of innovative treatments for other public safety professions. Trial Registration: ClinicalTrials.gov NCT04666974; https://www.clinicaltrials.gov/ct2/show/NCT04666974 International Registered Report Identifier (IRRID): DERR1-10.2196/30845 ",
doi="10.2196/30845",
url="https://www.researchprotocols.org/2021/7/e30845",
url="http://www.ncbi.nlm.nih.gov/pubmed/34088656"
}


@Article{info:doi/10.2196/26817,
author="Tawfik, S. Daniel
and Sinha, Amrita
and Bayati, Mohsen
and Adair, C. Kathryn
and Shanafelt, D. Tait
and Sexton, Bryan J.
and Profit, Jochen",
title="Frustration With Technology and its Relation to Emotional Exhaustion Among Health Care Workers: Cross-sectional Observational Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="6",
volume="23",
number="7",
pages="e26817",
keywords="frustration with technology",
keywords="emotional exhaustion",
keywords="professional burnout",
keywords="work-life integration",
keywords="biomedical technology",
keywords="work-life balance",
keywords="user-centered design",
keywords="electronic health records",
keywords="medical informatics applications",
keywords="health information systems",
abstract="Background: New technology adoption is common in health care, but it may elicit frustration if end users are not sufficiently considered in their design or trained in their use. These frustrations may contribute to burnout. Objective: This study aimed to evaluate and quantify health care workers' frustration with technology and its relationship with emotional exhaustion, after controlling for measures of work-life integration that may indicate excessive job demands. Methods: This was a cross-sectional, observational study of health care workers across 31 Michigan hospitals. We used the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey to measure work-life integration and emotional exhaustion among the survey respondents. We used mixed-effects hierarchical linear regression to evaluate the relationship among frustration with technology, other components of work-life integration, and emotional exhaustion, with adjustment for unit and health care worker characteristics. Results: Of 15,505 respondents, 5065 (32.7\%) reported that they experienced frustration with technology on at least 3-5 days per week. Frustration with technology was associated with higher scores for the composite Emotional Exhaustion scale (r=0.35, P<.001) and each individual item on the Emotional Exhaustion scale (r=0.29-0.36, P<.001 for all). Each 10-point increase in the frustration with technology score was associated with a 1.2-point increase (95\% CI 1.1-1.4) in emotional exhaustion (both measured on 100-point scales), after adjustment for other work-life integration items and unit and health care worker characteristics. Conclusions: This study found that frustration with technology and several other markers of work-life integration are independently associated with emotional exhaustion among health care workers. Frustration with technology is common but not ubiquitous among health care workers, and it is one of several work-life integration factors associated with emotional exhaustion. Minimizing frustration with health care technology may be an effective approach in reducing burnout among health care workers. ",
doi="10.2196/26817",
url="https://www.jmir.org/2021/7/e26817",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255674"
}


@Article{info:doi/10.2196/28729,
author="Heponiemi, Tarja
and Kaihlanen, Anu-Marja
and Gluschkoff, Kia
and Saranto, Kaija
and Nissinen, Sari
and Laukka, Elina
and Vehko, Tuulikki",
title="The Association Between Using a Mobile Version of an Electronic Health Record and the Well-Being of Nurses: Cross-sectional Survey Study",
journal="JMIR Med Inform",
year="2021",
month="Jul",
day="6",
volume="9",
number="7",
pages="e28729",
keywords="stress related to information systems",
keywords="time pressure",
keywords="usability",
keywords="stress",
keywords="health and social care",
abstract="Background: Mobile devices such as tablets and smartphones are increasingly being used in health care in many developed countries. Nurses form the largest group in health care that uses electronic health records (EHRs) and their mobile versions. Mobile devices are suggested to promote nurses' workflow, constant updating of patient information, and improve the communication within the health care team. However, little is known about their effect on nurses' well-being. Objective: This study aimed to examine the association between using a mobile version of the EHR and nurses' perceived time pressure, stress related to information systems, and self-rated stress. Moreover, we examined whether mobile device use modifies the associations of EHR usability (ease of use and technical quality), experience in using EHRs, and number of systems in daily use with these well-being indicators. Methods: This was a cross-sectional population-based survey study among 3610 Finnish registered nurses gathered in 2020. The aforesaid associations were examined using analyses of covariance and logistic regression adjusted for age, gender, and employment sector (hospital, primary care, social service, and other). Results: Nurses who used the mobile version of their EHR had higher levels of time pressure (F1,3537=14.96, P<.001) and stress related to information systems (F1,3537=6.11, P=.01), compared with those who did not use mobile versions. Moreover, the interactions of mobile device use with experience in using EHRs (F1,3581=14.93, P<.001), ease of use (F1,3577=10.16, P=.001), and technical quality (F1,3577=6.45, P=.01) were significant for stress related to information systems. Inexperience in using EHRs, low levels of ease of use, and technical quality were associated with higher stress related to information systems and this association was more pronounced among those who used mobile devices. That is, the highest levels of stress related to information systems were perceived among those who used mobile devices as well as among inexperienced EHR users or those who perceived usability problems in their EHRs. Conclusions: According to our results, it seems that at present mobile device use is not beneficial for the nurses' well-being. In addition, mobile device use seems to intensify the negative effects of usability issues related to EHRs. In particular, inexperienced users of EHRs seem to be at a disadvantage when using mobile devices. Thus, we suggest that EHRs and their mobile versions should be improved such that they would be easier to use and would better support the nurses' workflow (eg, improvements to problems related to small display, user interface, and data entry). Moreover, additional training on EHRs, their mobile versions, and workflow related to these should be provided to nurses. ",
doi="10.2196/28729",
url="https://medinform.jmir.org/2021/7/e28729",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255704"
}


@Article{info:doi/10.2196/27774,
author="Jeannotte, M. Alexis
and Hutchinson, M. Derek
and Kellerman, R. Gabriella",
title="Time to Change for Mental Health and Well-being via Virtual Professional Coaching: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="5",
volume="23",
number="7",
pages="e27774",
keywords="professional coaching",
keywords="virtual coaching",
keywords="mental health",
keywords="psychological well-being",
keywords="stress",
keywords="resilience",
keywords="life satisfaction",
keywords="longitudinal",
keywords="intervention",
keywords="well-being",
keywords="satisfaction",
keywords="coach",
keywords="observational",
abstract="Background: Optimal mental health yields many benefits and reduced costs to employees and organizations; however, the workplace introduces challenges to building and maintaining mental health that affect well-being. Although many organizations have introduced programming to aid employee mental health and well-being, the uptake and effectiveness of these efforts vary. One barrier to developing more effective interventions is a lack of understanding about how to improve well-being over time. This study examined not only whether employer-provided coaching is an effective strategy to improve mental health and well-being in employees but also how this intervention changes well-being in stages over time. Objective: The goal of this study was to determine whether BetterUp, a longitudinal one-on-one virtual coaching intervention, improves components of mental health and psychological well-being, and whether the magnitude of changes vary in stages over time. This is the first research study to evaluate the effectiveness of professional coaching through three repeated assessments, moving beyond a pre-post intervention design. The outcomes of this study will enable coaches and employers to design more targeted interventions by outlining when to expect maximal growth in specific outcomes throughout the coaching engagement. Methods: Three identical assessments were completed by 391 users of BetterUp: prior to the start of coaching, after approximately 3-4 months of coaching, and again after 6-7 months of coaching. Three scales were used to evaluate psychological and behavioral dimensions that support management of mental health: stress management, resilience, and life satisfaction. Six additional scales were used to assess psychological well-being: emotional regulation, prospection ability, finding purpose and meaning, self-awareness, self-efficacy, and social connection. Results: Using mixed-effects modeling, varying rates of change were observed in several dimensions of mental health and psychological well-being. Initial rapid improvements in the first half of the intervention, followed by slower growth in the second half of the intervention were found for prospection ability, self-awareness, self-efficacy, social connection, emotional regulation, and a reduction in stress (range of unstandardized $\beta$ values for each assessment: .10-.19). Life satisfaction improved continuously throughout the full intervention period ($\beta$=.13). Finding purpose in meaning at work and building resilience both grew continuously throughout the coaching intervention, but larger gains were experienced in the second half of the intervention ($\beta$=.08-.18), requiring the full length of the intervention to realize maximal growth. Conclusions: The results demonstrate the effectiveness of BetterUp virtual one-on-one coaching to improve psychological well-being, while mitigating threats to mental health such as excessive and prolonged stress, low resilience, and poor satisfaction with life. The improvements across the collection of outcomes were time-dependent, and provide important insights to users and practitioners about how and when to expect maximal improvements in a range of interrelated personal and professional outcomes. ",
doi="10.2196/27774",
url="https://www.jmir.org/2021/7/e27774",
url="http://www.ncbi.nlm.nih.gov/pubmed/33993102"
}


@Article{info:doi/10.2196/22075,
author="Ye, Jiancheng",
title="Advancing Mental Health and Psychological Support for Health Care Workers Using Digital Technologies and Platforms",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="30",
volume="5",
number="6",
pages="e22075",
keywords="mental health",
keywords="health care workers",
keywords="health informatics",
keywords="digital intervention",
keywords="health technology",
keywords="mobile health",
keywords="COVID-19",
abstract="Background: The COVID-19 pandemic is a global public health crisis that has not only endangered the lives of patients but also resulted in increased psychological issues among medical professionals, especially frontline health care workers. As the crisis caused by the pandemic shifts from acute to protracted, attention should be paid to the devastating impacts on health care workers' mental health and social well-being. Digital technologies are being harnessed to support the responses to the pandemic, which provide opportunities to advance mental health and psychological support for health care workers. Objective: The aim of this study is to develop a framework to describe and organize the psychological and mental health issues that health care workers are facing during the COVID-19 pandemic. Based on the framework, this study also proposes interventions from digital health perspectives that health care workers can leverage during and after the pandemic. Methods: The psychological problems and mental health issues that health care workers have encountered during the COVID-19 pandemic were reviewed and analyzed based on the proposed MEET (Mental Health, Environment, Event, and Technology) framework, which also demonstrated the interactions among mental health, digital interventions, and social support. Results: Health care workers are facing increased risk of experiencing mental health issues due to the COVID-19 pandemic, including burnout, fear, worry, distress, pressure, anxiety, and depression. These negative emotional stressors may cause psychological problems for health care workers and affect their physical and mental health. Digital technologies and platforms are playing pivotal roles in mitigating psychological issues and providing effective support. The proposed framework enabled a better understanding of how to mitigate the psychological effects during the pandemic, recover from associated experiences, and provide comprehensive institutional and societal infrastructures for the well-being of health care workers. Conclusions: The COVID-19 pandemic presents unprecedented challenges due to its prolonged uncertainty, immediate threat to patient safety, and evolving professional demands. It is urgent to protect the mental health and strengthen the psychological resilience of health care workers. Given that the pandemic is expected to exist for a long time, caring for mental health has become a ``new normal'' that needs a strengthened multisector collaboration to facilitate support and reduce health disparities. The proposed MEET framework could provide structured guidelines for further studies on how technology interacts with mental and psychological health for different populations. ",
doi="10.2196/22075",
url="https://formative.jmir.org/2021/6/e22075",
url="http://www.ncbi.nlm.nih.gov/pubmed/34106874"
}


@Article{info:doi/10.2196/28925,
author="Lutrick, Karen
and Ellingson, D. Katherine
and Baccam, Zoe
and Rivers, Patrick
and Beitel, Shawn
and Parker, Joel
and Hollister, James
and Sun, Xiaoxiao
and Gerald, K. Joe
and Komatsu, Kenneth
and Kim, Elizabeth
and LaFleur, Bonnie
and Grant, Lauren
and Yoo, M. Young
and Kumar, Archana
and Mayo Lamberte, Julie
and Cowling, J. Benjamin
and Cobey, Sarah
and Thornburg, J. Natalie
and Meece, K. Jennifer
and Kutty, Preeta
and Nikolich-Zugich, Janko
and Thompson, G. Mark
and Burgess, L. Jefferey",
title="COVID-19 Infection, Reinfection, and Vaccine Effectiveness in Arizona Frontline and Essential Workers: Protocol for a Longitudinal Cohort Study",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="24",
volume="10",
number="6",
pages="e28925",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="health care personnel",
keywords="first responders",
keywords="essential workers",
abstract="Background: COVID-19 has spread worldwide since late 2019, with an unprecedented case count and death toll globally. Health care personnel (HCP), first responders, and other essential and frontline workers (OEWs) are at increased risk of SARS-CoV-2 infection because of frequent close contact with others. Objective: The Arizona Healthcare, Emergency Response, and Other Essential Workers Study (AZ HEROES) aims to examine the epidemiology of SARS-CoV-2 infection and COVID-19 illness among adults with high occupational exposure risk. Study objectives include estimating the incidence of SARS-CoV-2 infection in essential workers by symptom presentation and demographic factors, determining independent effects of occupational and community exposures on incidence of SARS-CoV-2 infection, establishing molecular and immunologic characteristics of SARS-CoV-2 infection in essential workers, describing the duration and patterns of real-time reverse transcription--polymerase chain reaction (rRT-PCR) positivity, and examining postvaccine immunologic response. Methods: Eligible participants include Arizona residents aged 18 to 85 years who work at least 20 hours per week in an occupation involving regular direct contact (ie, within 3 feet) with others. Recruitment goals are stratified by demographic characteristics (50\% aged 40 years or older, 50\% women, and 50\% Hispanic or American Indian), by occupation (40\% HCP, 30\% first responders, and 30\% OEWs), and by prior SARS-CoV-2 infection (with up to 50\% seropositive at baseline). Information on sociodemographics, health and medical history, vaccination status, exposures to individuals with suspected or confirmed SARS-CoV-2 infection, use of personal protective equipment, and perceived risks are collected at enrollment and updated through quarterly surveys. Every week, participants complete active surveillance for COVID-like illness (CLI) and self-collect nasal swabs. Additional self-collected nasal swab and saliva specimens are collected in the event of CLI onset. Respiratory specimens are sent to Marshfield Laboratories and tested for SARS-CoV-2 by rRT-PCR assay. CLI symptoms and impact on work and productivity are followed through illness resolution. Serum specimens are collected every 3 months and additional sera are collected following incident rRT-PCR positivity and after each COVID-19 vaccine dose. Incidence of SARS-CoV-2 infections will be calculated by person-weeks at risk and compared by occupation and demographic characteristics as well as by seropositivity status and infection and vaccination history. Results: The AZ HEROES study was funded by the US Centers for Disease Control and Prevention. Enrollment began on July 27, 2020; as of May 1, 2021, a total of 3165 participants have been enrolled in the study. Enrollment is expected to continue through December 1, 2021, with data collection continuing through at least April 2022, contingent upon funding. Conclusions: AZ HEROES is unique in aiming to recruit a diverse sample of essential workers and to prospectively follow strata of SARS-CoV-2 seronegative and seropositive adults. Survey results combined with active surveillance data on exposure, CLI, weekly molecular diagnostic testing, and periodic serology will be used to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infection, assess the intensity and durability of immune responses to natural infection and COVID-19 vaccination, and contribute to the evaluation of COVID-19 vaccine effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/28925 ",
doi="10.2196/28925",
url="https://www.researchprotocols.org/2021/6/e28925/"
}


@Article{info:doi/10.2196/26085,
author="Bernier, Th{\'e}r{\`e}se
and Shah, Amika
and Ross, E. Lori
and Logie, H. Carmen
and Seto, Emily",
title="The Use of Information and Communication Technologies by Sex Workers to Manage Occupational Health and Safety: Scoping Review",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="24",
volume="23",
number="6",
pages="e26085",
keywords="sex work",
keywords="smartphone",
keywords="mobile phone",
keywords="occupational health and safety",
keywords="online",
keywords="internet",
keywords="website",
abstract="Background: In many countries, sex work is criminalized, driving sex work underground and leaving sex workers vulnerable to a number of occupational health and safety risks, including violence, assault, and robbery. With the advent of widely accessible information and communication technologies (ICTs), sex workers have begun to use electronic occupational health and safety tools to mitigate these risks. Objective: This study aims to explore the use of ICTs by sex workers for managing occupational health and safety risks and strategies for reducing these risks. This paper aims to answer the following question: what is known about sex workers' use of ICTs in the delivery of occupational health and safety strategies? Methods: A literature review following the methodological framework for scoping reviews was conducted to analyze studies describing the use of ICTs by sex workers to mitigate occupational health and safety risks. Experimental, observational, and descriptive studies, as well as protocol papers, were included in this scoping review. Results: Of the 2477 articles initially identified, 41 (1.66\%) met the inclusion criteria. Of these studies, 71\% (29/41) were published between 2015 and 2019. In these studies, the internet was the predominant ICT (24/41, 58\%), followed by text messaging (10/41, 24\%) and assorted communication technologies associated with mobile phones without internet access (7/41, 17\%; eg, voice mail). In 56\% (23/41) of the studies, sex workers located in high-income countries created occupational health and safety strategies (eg, bad date lists) and shared them through the internet. In 24\% (10/41) of the studies, mostly in low- and middle-income countries, organizations external to sex work developed and sent (through text messages) occupational health and safety strategies focused on HIV. In 20\% (8/41) of the studies, external organizations collaborated with the sex worker community in the development of occupational health and safety strategies communicated through ICTs; through this collaboration, concerns other than HIV (eg, mental health) emerged. Conclusions: Although there has been an increase in the number of studies on the use of ICTs by sex workers for managing occupational health and safety over the past 5 years, knowledge of how to optimally leverage ICTs for this purpose remains scarce. Recommendations for expanding the use of ICTs by sex workers for occupational health and safety include external organizations collaborating with sex workers in the design of ICT interventions to mitigate occupational health and safety risks; to examine whether ICTs used in low- and middle-income countries would have applications in high-income countries as a substitute to the internet for sharing occupational health and safety strategies; and to explore the creation of innovative, secure, web-based communities that use existing or alternative digital technologies that could be used by sex workers to manage their occupational health and safety. ",
doi="10.2196/26085",
url="https://www.jmir.org/2021/6/e26085/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34185001"
}


@Article{info:doi/10.2196/29869,
author="Lecours, Alexandra
and Major, Marie-{\`E}ve
and Vincent, Claude
and Lederer, Val{\'e}rie
and Lamontagne, Marie-{\`E}ve",
title="Integrated Prevention at Work: Protocol for a Concept Analysis",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="17",
volume="10",
number="6",
pages="e29869",
keywords="integrated prevention at work",
keywords="concept analysis",
keywords="occupational injury",
keywords="meta-narrative review",
keywords="qualitative research",
keywords="focus groups",
abstract="Background: Integrated prevention at work promises to eliminate the boundaries between primary, secondary, and tertiary prevention actions taken by stakeholders in the world of work. It is receiving increasing attention from the scientific community because of its concerted and harmonized approach, which promotes employment access, return, and healthy long-term continuation. Although promising, integrated prevention is not yet well-defined, which makes it difficult to operationalize. Objective: This manuscript exposes the protocol of a study aiming to conceptualize integrated prevention at work on the basis of scientific and experiential knowledge. Methods: Using a concept analysis research design, data collection has been planned in 2 parts. A meta-narrative literature review will first be conducted to document how integrated prevention has been defined in the literature. Then, phone interviews will be conducted with key informers (ie, managers, workers, ergonomists, occupational therapists, psychologists, physiotherapists, union and insurance representatives) to document their viewpoints and understanding of integrated prevention at work. Qualitative data gathered during these 2 parts of research will be analyzed using template analysis, which allows data from literature and empirical collection to be analyzed simultaneously. The analysis will bring out the points of convergence, divergence, and complementarity between the information gleaned from literature and key informers' experiences to arrive at a conceptualization of integrated prevention at work by identifying its uses, attributes, antecedents, and consequences. As a final step, validation and interpretation with a TRIAGE (Technique for Research of Information by Animation of a Group of Experts) group will be carried out in collaboration with the key informers to identify the tools for the implementation of integrated prevention at work and promote workers' health and safety. Results: This study is expected to offer a contemporary conceptualization of integrated prevention at work that clearly lays out the variables of this concept and elicits the viewpoints of the different stakeholders. Conclusions: This study will contribute to the advancement of knowledge about the professional injury prevention continuum. The clear identification of the uses, attributes, antecedents, and consequences of integrated prevention at work will offer concrete tools to stakeholders to implement innovative and promising approaches to integrated prevention at work. International Registered Report Identifier (IRRID): PRR1-10.2196/29869 ",
doi="10.2196/29869",
url="https://www.researchprotocols.org/2021/6/e29869",
url="http://www.ncbi.nlm.nih.gov/pubmed/34137727"
}


@Article{info:doi/10.2196/29036,
author="Oksa, Reetta
and Kaakinen, Markus
and Savela, Nina
and Hakanen, J. Jari
and Oksanen, Atte",
title="Professional Social Media Usage and Work Engagement Among Professionals in Finland Before and During the COVID-19 Pandemic: Four-Wave Follow-Up Study",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="15",
volume="23",
number="6",
pages="e29036",
keywords="COVID-19",
keywords="engagement",
keywords="mental health",
keywords="moderator",
keywords="predictor",
keywords="psychological distress",
keywords="social media",
keywords="social support",
keywords="support",
keywords="task resources",
keywords="usage",
keywords="work engagement",
abstract="Background: The COVID-19 pandemic has changed work life profoundly and concerns regarding the mental well-being of employees' have arisen. Organizations have made rapid digital advancements and have started to use new collaborative tools such as social media platforms overnight. Objective: Our study aimed to investigate how professional social media communication has affected work engagement before and during the COVID-19 pandemic and the role of perceived social support, task resources, and psychological distress as predictors and moderators of work engagement. Methods: Nationally representative longitudinal survey data were collected in 2019-2020, and 965 respondents participated in all 4 surveys. Measures included work engagement, perceived social support and task resources, and psychological distress. The data were analyzed using a hybrid linear regression model.? Results: Work engagement remained stable and only decreased in autumn 2020. Within-person changes in social media communication at work, social support, task resources, and psychological distress were all associated with work engagement. The negative association between psychological distress and work engagement was stronger in autumn 2020 than before the COVID-19 outbreak. Conclusions: The COVID-19 pandemic has exerted pressure on mental health at work. Fostering social support and task resources at work is important in maintaining work engagement. Social media communication could help maintain a supportive work environment. ",
doi="10.2196/29036",
url="https://www.jmir.org/2021/6/e29036",
url="http://www.ncbi.nlm.nih.gov/pubmed/34048356"
}


@Article{info:doi/10.2196/28055,
author="Heyen, Marie Janna
and Weigl, No{\'e}
and M{\"u}ller, Mario
and M{\"u}ller, Stefan
and Eberle, Urs
and Manoliu, Andrei
and Vetter, Stefan
and Brown, D. Adam
and Berger, Thomas
and Kleim, Birgit",
title="Multimodule Web-Based COVID-19 Anxiety and Stress Resilience Training (COAST): Single-Cohort Feasibility Study With First Responders",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="7",
volume="5",
number="6",
pages="e28055",
keywords="anxiety",
keywords="COVID-19",
keywords="electronic mental health",
keywords="feasibility",
keywords="first responder",
keywords="mental health",
keywords="mindfulness",
keywords="resilience",
keywords="self-efficacy",
keywords="sleep quality",
keywords="stress",
keywords="training",
abstract="Background: Since the emergence of COVID-19, health care workers and first responders have been at a high risk for mental health symptoms owing to their exposure to the virus and increased work stress during the pandemic. Although interventions exist to address mental health issues following exposure to disasters, emergencies, and humanitarian crises, considerably less is known about web-based unguided interventions to help mitigate the negative impacts of such events. Additionally, in contexts in which emergencies reduce access to in-person care, remote forms of support are critical, yet there are limited studies on the use of such interventions. Evidence-based, easy-to-use, scalable interventions are direly needed for this population. Objective: This study aimed to develop and test the feasibility of an unguided electronic mental health program, COVID-19 Anxiety and Stress Resilience Training (COAST), tailored to first responders and health care personnel, based on scientific evidence and empirically based techniques. Methods: We developed COVID-19--specific training modules focusing on several domains that are previously reported as key to resilience and stress recovery: self-efficacy, mindfulness, sleep quality, and positive thinking. The program was made available to 702 first responders between May and August 2020, during the COVID-19 pandemic. Sociodemographic, work-, and COVID-19--related information was collected, and psychometric questionnaires were completed. We examined user acceptance and user activity, including module choice and participant feedback. Results: In total, 52 of 702 (7\%) first responders to whom we reached out used the program at least once. COAST use was independent of age, sex, or baseline levels of self-efficacy, mindful awareness, sleep quality, and positive thinking (for all, P>.39). First responders who had tested positive and those who had been quarantined were more likely to engage in the program. A click count analysis per module showed that participants used the self-efficacy and mindfulness modules most often, with 382 and 122 clicks, respectively, over 15 weeks. Overall, first responders expressed satisfaction with the program. Conclusions: Engagement of first responders in the multimodule web-based COAST program was feasible and the first responder cohort expressed overall satisfaction with the program. Those in more difficult circumstances, including those in quarantine and those who tested positive, may be more likely to engage in such programs. Further controlled studies could pave the way for efficacy studies and the development of additional modules, including just-in-time interventions or blended interventions combining individual use of an unguided self-help intervention, such as COAST, with subsequent individual psychotherapy for those who continue to experience stress and psychological symptoms. ",
doi="10.2196/28055",
url="https://formative.jmir.org/2021/6/e28055",
url="http://www.ncbi.nlm.nih.gov/pubmed/33999835"
}


@Article{info:doi/10.2196/25261,
author="Gilroy, John
and Bulkeley, Kim
and Talbot, Folau
and Gwynn, Josephine
and Gwynne, Kylie
and Henningham, Mandy
and Alcorso, Caroline
and Rambaldini, Boe
and Lincoln, Michelle",
title="Retention of the Aboriginal Health, Ageing, and Disability Workforce: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="28",
volume="10",
number="5",
pages="e25261",
keywords="Indigenous health",
keywords="disability",
keywords="ageing",
keywords="Indigenous methodologies",
keywords="Indigenous",
keywords="Australia",
keywords="Aboriginal",
abstract="Background: Despite a plethora of research into Aboriginal employment and recruitment, the extent and nature of the retention of frontline Aboriginal people in health, ageing, and disability workforces are currently unknown. In this application, frontline service delivery is defined as Aboriginal people who are paid employees in the health, ageing, and disability service sectors in roles that involve direct client, participant, or patient contact. There is a need to identify the factors that inhibit (push) and promote (pull) staff retention or departure of this workforce from the sectors. This study will provide additional insight about this topic. Objective: The objective of this project is to uncover the factors that influence the retention of frontline Aboriginal workers in the health, ageing, and disability workforces in New South Wales (NSW) who do not have university qualifications. The aim of the proposed project aims to discover the push and pull factors for the retention of the frontline Aboriginal workforce in the health, ageing, and disability sectors in NSW in relation to their role, employment, and community and design evidence-based strategies for retaining the Aboriginal frontline workforce in the health, ageing, and disability sectors in NSW. Methods: The proposed research will use a mixed methods approach, collecting both quantitative and qualitative data via surveys and interviews to capture and represent the voices and perspectives of Aboriginal people in a way that the participants chose. Results: Indigenous research methodologies are a growing field in Aboriginal health research in Australia. A key strength of this study is that it is led by Aboriginal scholars and Aboriginal controlled organizations that apply an Indigenous methodological framework throughout the research process. Conclusions: This study uses a mixed methods design. The survey and interview questions and model were developed in partnership with Aboriginal health, ageing, and disability service workers rather than relying only on research publications on the workforce, government policies, and human resources strategies. This design places a strong emphasis on generalizable findings together with an inductive approach that explores employers and workers' lived experience of the Aboriginal health workforce in NSW. Excluding workers who have graduated from university places a strong focus on the workforce who have obtained either school or Technical and Further Education or registered training organizations qualifications. Data collection was conducted during the COVID-19 pandemic, and results will include the unique experiences of Aboriginal workers and employers delivering services in an extremely challenging organizational, community, and personal context. International Registered Report Identifier (IRRID): PRR1-10.2196/25261 ",
doi="10.2196/25261",
url="https://www.researchprotocols.org/2021/5/e25261",
url="http://www.ncbi.nlm.nih.gov/pubmed/34047698"
}


@Article{info:doi/10.2196/22851,
author="Zahiri Harsini, Azita
and Bohle, Philip
and Matthews, R. Lynda
and Ghofranipour, Fazlollah
and Sanaeinasab, Hormoz
and Amin Shokravi, Farkhondeh
and Prasad, Krishan",
title="Evaluating the Consistency Between Conceptual Frameworks and Factors Influencing the Safe Behavior of Iranian Workers in the Petrochemical Industry: Mixed Methods Study",
journal="JMIR Public Health Surveill",
year="2021",
month="May",
day="27",
volume="7",
number="5",
pages="e22851",
keywords="safe behavior",
keywords="petrochemical industry",
keywords="conceptual frameworks",
keywords="literature review",
keywords="occupational health",
abstract="Background: Unsafe worker behavior is often identified as a major cause of dangerous incidents in the petrochemical industry. Behavioral safety models provide frameworks that may help to prevent such incidents by identifying factors promoting safe or unsafe behavior. We recently conducted a qualitative study to identify factors affecting workers' unsafe behaviors in an Iranian petrochemical company. Objective: The aims of this study were to (1) conduct a review of the relevant research literature between the years 2000 and 2019 to identify theoretical models proposed to explain and predict safe behavior in the workplace and (2) to select the model that best reflects our qualitative findings and other evidence about the factors influencing safe behaviors among petrochemical workers. Methods: This research used mixed methods. Initially, we conducted a qualitative study of factors that Iranian petrochemical workers believed affected their safety behavior. Four themes emerged from the semistructured interviews: (1) poor direct safety management and supervision; (2) unsafe workplace conditions; (3) workers' perceptions, skills, and training; and (4) broader organizational factors. Electronic databases, including PubMed, Embase, Scopus, Google Scholar, EBSCOhost, and Science Direct, were then searched for eligible studies on models to explain and predict safe behaviors, which were published between the years 2000 and 2019. Medical subject headings were used as the primary analytical element. Medical subject headings and subheadings were then extracted from the literature. One researcher conducted the search and 3 researchers performed screening and data extraction. Then, constructs described in each study were assessed to determine which were the most consistent with themes derived from our qualitative analysis. Results: A total of 2032 publications were found using the search strategy. Of these, 142 studies were assessed and 28 studies met the inclusion criteria and were included in the review. The themes identified in the qualitative study most closely matched 3 scales included in Wu et al's model that measured safety behavior and performance, safety leadership, and safety climate in petrochemical industries. Poor direct safety management and supervision matched with safety leadership and its subscales; unsafe workplace conditions matched with safety climate and its subscales; workers' perceptions, skills, and training matched with safety performance and its subscales; and broader organizational factors matched with some subscales of the model. Conclusions: This is the first literature review to identify models intended to explain and predict safe behavior and select the model most consistent with themes elicited from a qualitative study. Our results showed that effective safety leadership and management and safety climate and culture systems are the most frequently identified factors affecting safe behaviors in the petrochemical industry. These results can further help safety researchers and professionals design effective behavior-based safety interventions, which can have a more sustainable and persistent impact on workers' safety behaviors. Trial Registration: Iranian Registry of Clinical Trials IRCT20170515033981N2; https://www.irct.ir/trial/26107 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7126-1 ",
doi="10.2196/22851",
url="https://publichealth.jmir.org/2021/5/e22851",
url="http://www.ncbi.nlm.nih.gov/pubmed/34042605"
}


@Article{info:doi/10.2196/27473,
author="Singh, Laura
and Kanstrup, Marie
and Depa, Katherine
and Falk, Ann-Charlotte
and Lindstr{\"o}m, Veronica
and Dahl, Oili
and G{\"o}ransson, E. Katarina
and Rudman, Ann
and Holmes, A. Emily",
title="Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma for Health Care Staff Working During COVID-19: Exploratory Pilot Study With Nurses",
journal="JMIR Form Res",
year="2021",
month="May",
day="26",
volume="5",
number="5",
pages="e27473",
keywords="intrusive memories",
keywords="psychological trauma",
keywords="prevention",
keywords="pilot trial",
keywords="COVID-19",
keywords="digital intervention",
keywords="remote delivery",
keywords="cognitive science",
keywords="person-based approach",
keywords="mixed methods",
keywords="co-design",
keywords="health care staff",
abstract="Background: The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19--related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff's working context in a hospital setting used a co-design approach. Objective: The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant's perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection. Methods: We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis. Results: After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100\% digital data capture). Prior to study inclusion,  two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure. Conclusions: The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial. ",
doi="10.2196/27473",
url="https://formative.jmir.org/2021/5/e27473",
url="http://www.ncbi.nlm.nih.gov/pubmed/33886490"
}


@Article{info:doi/10.2196/27331,
author="Stewart, H. Nancy
and Koza, Anya
and Dhaon, Serena
and Shoushtari, Christiana
and Martinez, Maylyn
and Arora, M. Vineet",
title="Sleep Disturbances in Frontline Health Care Workers During the COVID-19 Pandemic: Social Media Survey Study",
journal="J Med Internet Res",
year="2021",
month="May",
day="19",
volume="23",
number="5",
pages="e27331",
keywords="social media",
keywords="sleep disorders",
keywords="frontline health care workers",
keywords="burnout",
keywords="insomnia",
keywords="sleep",
keywords="health care worker",
keywords="stress",
keywords="survey",
keywords="demographic",
keywords="outcome",
keywords="COVID-19",
abstract="Background: During the COVID-19 pandemic, health care workers are sharing their challenges, including sleep disturbances, on social media; however, no study has evaluated sleep in predominantly US frontline health care workers during the COVID-19 pandemic. Objective: The aim of this study was to assess sleep among a sample of predominantly US frontline health care workers during the COVID-19 pandemic using validated measures through a survey distributed on social media. Methods: A self-selection survey was distributed on Facebook, Twitter, and Instagram for 16 days (August 31 to September 15, 2020), targeting health care workers who were clinically active during the COVID-19 pandemic. Study participants completed the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI), and they reported their demographic and career information. Poor sleep quality was defined as a PSQI score ?5. Moderate-to-severe insomnia was defined as an ISI score >14. The Mini-Z Burnout Survey was used to measure burnout. Multivariate logistic regression tested associations between demographics, career characteristics, and sleep outcomes. Results: A total of 963 surveys were completed. Participants were predominantly White (894/963, 92.8\%), female (707/963, 73.4\%), aged 30-49 years (692/963, 71.9\%), and physicians (620/963, 64.4\%). Mean sleep duration was 6.1 hours (SD 1.2). Nearly 96\% (920/963, 95.5\%) of participants reported poor sleep (PSQI). One-third (288/963, 30\%) reported moderate or severe insomnia. Many participants (554/910, 60.9\%) experienced sleep disruptions due to device use or had nightmares at least once per week (420/929, 45.2\%). Over 50\% (525/932, 56.3\%) reported burnout. In multivariable logistic regressions, nonphysician (odds ratio [OR] 2.4, 95\% CI 1.7-3.4), caring for patients with COVID-19 (OR 1.8, 95\% CI 1.2-2.8), Hispanic ethnicity (OR 2.2, 95\% CI 1.4-3.5), female sex (OR 1.6, 95\% CI 1.1-2.4), and having a sleep disorder (OR 4.3, 95\% CI 2.7-6.9) were associated with increased odds of insomnia. In open-ended comments (n=310), poor sleep was mapped to four categories: children and family, work demands, personal health, and pandemic-related sleep disturbances. Conclusions: During the COVID-19 pandemic, nearly all the frontline health care workers surveyed on social media reported poor sleep, over one-third reported insomnia, and over half reported burnout. Many also reported sleep disruptions due to device use and nightmares. Sleep interventions for frontline health care workers are urgently needed. ",
doi="10.2196/27331",
url="https://www.jmir.org/2021/5/e27331",
url="http://www.ncbi.nlm.nih.gov/pubmed/33875414"
}


@Article{info:doi/10.2196/27963,
author="Pereira, Filipa
and Querido, Isabel Ana
and Bieri, Marion
and Verloo, Henk
and Laranjeira, Ant{\'o}nio Carlos",
title="Presenteeism Among Nurses in Switzerland and Portugal and Its Impact on Patient Safety and Quality of Care: Protocol for a Qualitative Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="13",
volume="10",
number="5",
pages="e27963",
keywords="healthcare",
keywords="nurses",
keywords="predictors",
keywords="presenteeism",
keywords="quality of care",
keywords="frontline",
keywords="managers",
keywords="Portugal",
keywords="Switzerland",
keywords="patient safety",
keywords="patients",
keywords="safety",
keywords="stress",
keywords="emotion",
keywords="knowledge transfer",
keywords="acute care",
keywords="long-term care",
abstract="Background: Nurses dispense direct care in a wide variety of settings and are considered the backbone of the health care system. They often work long hours, face emotional stress, and are at a high risk of psychosocial and somatic illnesses. Nurses sometimes fall sick but work regardless, leading to presenteeism and subsequent risks to quality of care and patient safety due to the increased likelihood of patients falling, medication errors, and staff-to-patient disease transmission. Objective: This study aims to understand presenteeism among frontline nurses and nurse managers in acute, primary, and long-term health care settings and to contribute to the development of future interventional studies and recommendations. Methods: A qualitative study based on online focus group discussions will explore the perceptions of, attitudes to, and experiences with presenteeism among frontline nurses and nurse managers. Using a pilot-tested interview guide, 8 focus group discussions will involve nurses working in acute care hospitals, primary care settings, and long-term residential care facilities in Switzerland's French-speaking region and Portugal's Center region. The data collected will be examined using a content analysis approach via NVivo 12 QSR International software. Results: The University of Applied Sciences and Arts Western Switzerland's School of Health Sciences and the Polytechnic of Leiria's School of Health Sciences in Portugal have both approved funding for the study. The research protocol has been approved by ethics committees in both countries. Study recruitment commenced in February 2021. The results of the data analysis are expected by September 2021. Conclusions: This present study aims to gain more insight into the dilemmas facing nurses as a result of all causes of presenteeism among frontline nurses and nurse managers in different health care settings. The researchers will prepare manuscripts on the study's findings, publish them in relevant peer-reviewed journals, exhibit them in poster presentations, and give oral presentations at appropriate academic and nonscientific conferences. Regarding further knowledge transfer, researchers will engage with stakeholders to craft messages focused on the needs of nurses and nurse managers and on disseminating our research findings to deal with the issue of nursing presenteeism. International Registered Report Identifier (IRRID): PRR1-10.2196/27963 ",
doi="10.2196/27963",
url="https://www.researchprotocols.org/2021/5/e27963",
url="http://www.ncbi.nlm.nih.gov/pubmed/33983134"
}


@Article{info:doi/10.2196/29562,
author="Clingan, A. Caroline
and Dittakavi, Manasa
and Rozwadowski, Michelle
and Gilley, N. Kristen
and Cislo, R. Christine
and Barabas, Jenny
and Sandford, Erin
and Olesnavich, Mary
and Flora, Christopher
and Tyler, Jonathan
and Mayer, Caleb
and Stoneman, Emily
and Braun, Thomas
and Forger, B. Daniel
and Tewari, Muneesh
and Choi, Won Sung",
title="Monitoring Health Care Workers at Risk for COVID-19 Using Wearable Sensors and Smartphone Technology: Protocol for an Observational mHealth Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="12",
volume="10",
number="5",
pages="e29562",
keywords="mobile health",
keywords="app",
keywords="mHealth",
keywords="wearable",
keywords="sensor",
keywords="COVID-19",
keywords="health care worker",
keywords="frontline worker",
keywords="smartphone",
keywords="digital health",
abstract="Background: Health care workers (HCWs) have been working on the front lines of the COVID-19 pandemic with high risks of viral exposure, infection, and transmission. Standard COVID-19 testing is insufficient to protect HCWs from these risks and prevent the spread of disease. Continuous monitoring of physiological data with wearable sensors, self-monitoring of symptoms, and asymptomatic COVID-19 testing may aid in the early detection of COVID-19 in HCWs and may help reduce further transmission among HCWs, patients, and families. Objective: By using wearable sensors, smartphone-based symptom logging, and biospecimens, this project aims to assist HCWs in self-monitoring COVID-19. Methods: We conducted a prospective, longitudinal study of HCWs at a single institution. The study duration was 1 year, wherein participants were instructed on the continuous use of two wearable sensors (Fitbit Charge 3 smartwatch and TempTraq temperature patches) for up to 30 days. Participants consented to provide biospecimens (ie, nasal swabs, saliva swabs, and blood) for up to 1 year from study entry. Using a smartphone app called Roadmap 2.0, participants entered a daily mood score, submitted daily COVID-19 symptoms, and completed demographic and health-related quality of life surveys at study entry and 30 days later. Semistructured qualitative interviews were also conducted at the end of the 30-day period, following completion of daily mood and symptoms reporting as well as continuous wearable sensor use. Results: A total of 226 HCWs were enrolled between April 28 and December 7, 2020. The last participant completed the 30-day study procedures on January 16, 2021. Data collection will continue through January 2023, and data analyses are ongoing. Conclusions: Using wearable sensors, smartphone-based symptom logging and survey completion, and biospecimen collections, this study will potentially provide data on the prevalence of COVID-19 infection among HCWs at a single institution. The study will also assess the feasibility of leveraging wearable sensors and self-monitoring of symptoms in an HCW population. Trial Registration: ClinicalTrials.gov NCT04756869; https://clinicaltrials.gov/ct2/show/NCT04756869 International Registered Report Identifier (IRRID): DERR1-10.2196/29562 ",
doi="10.2196/29562",
url="https://www.researchprotocols.org/2021/5/e29562",
url="http://www.ncbi.nlm.nih.gov/pubmed/33945497"
}


@Article{info:doi/10.2196/26590,
author="Golden, A. Eddye
and Zweig, Micol
and Danieletto, Matteo
and Landell, Kyle
and Nadkarni, Girish
and Bottinger, Erwin
and Katz, Lindsay
and Somarriba, Ricardo
and Sharma, Vansh
and Katz, L. Craig
and Marin, B. Deborah
and DePierro, Jonathan
and Charney, S. Dennis",
title="A Resilience-Building App to Support the Mental Health of Health Care Workers in the COVID-19 Era: Design Process, Distribution, and Evaluation",
journal="JMIR Form Res",
year="2021",
month="May",
day="5",
volume="5",
number="5",
pages="e26590",
keywords="mHealth",
keywords="resilience",
keywords="mental health",
keywords="COVID-19",
keywords="HCWs",
keywords="digital health",
keywords="health app",
keywords="mental health platform",
keywords="mobile phone",
abstract="Background: The COVID-19 pandemic has resulted in increased strain on health care systems and negative psychological effects on health care workers (HCWs). This is anticipated to result in long-term negative mental health effects on the population, with HCWs representing a particularly vulnerable group. The scope of the COVID-19 pandemic necessitates the development of a scalable mental health platform to provide services to large numbers of at-risk or affected individuals. The Mount Sinai Health System in New York City was at the epicenter of the pandemic in the United States. Objective: The Center for Stress, Resilience, and Personal Growth (CSRPG) was created to address the current and anticipated psychological impact of the pandemic on the HCWs in the health system. The mission of the Center is to support the resilience and mental health of employees through educational offerings, outreach, and clinical care. Our aim was to build a mobile app to support the newly founded Center in its mission. Methods: We built the app as a standalone digital platform that hosts a suite of tools that users can interact with on a daily basis. With consideration for the Center's aims, we determined the overall vision, initiatives, and goals for the Wellness Hub app, followed by specific milestone tasks and deliverables for development. We defined the app's primary features based on the mental health assessment and needs of HCWs. Feature definition was informed by the results of a resilience survey widely distributed to Mount Sinai HCWs and by the resources offered at CSRPG, including workshop content. Results: We launched our app over the course of two phases, the first phase being a ``soft'' launch and the second being a broader launch to all of Mount Sinai. Of the 231 HCWs who downloaded the app, 173 (74.9\%) completed our baseline assessment of all mental health screeners in the app. Results from the baseline assessment show that more than half of the users demonstrate a need for support in at least one psychological area. As of 3 months after the Phase 2 launch, approximately 55\% of users re-entered the app after their first opening to explore additional features, with an average of 4 app openings per person. Conclusions: To address the mental health needs of HCWs during the COVID-19 pandemic, the Wellness Hub app was built and deployed throughout the Mount Sinai Health System. To our knowledge, this is the first resilience app of its kind. The Wellness Hub app is a promising proof of concept, with room to grow, for those who wish to build a secure mobile health app to support their employees, communities, or others in managing and improving mental and physical well-being. It is a novel tool offering mental health support broadly. ",
doi="10.2196/26590",
url="https://formative.jmir.org/2021/5/e26590",
url="http://www.ncbi.nlm.nih.gov/pubmed/33872189"
}


@Article{info:doi/10.2196/24014,
author="Akbar, Fatema
and Mark, Gloria
and Prausnitz, Stephanie
and Warton, Margaret E.
and East, A. Jeffrey
and Moeller, F. Mark
and Reed, E. Mary
and Lieu, A. Tracy",
title="Physician Stress During Electronic Health Record Inbox Work: In Situ Measurement With Wearable Sensors",
journal="JMIR Med Inform",
year="2021",
month="Apr",
day="28",
volume="9",
number="4",
pages="e24014",
keywords="electronic health records",
keywords="stress",
keywords="wearables",
keywords="HRV",
keywords="inbox",
keywords="EHR alerts",
keywords="after-hours work",
keywords="electronic mail",
keywords="physician well-being",
keywords="Inbasket",
abstract="Background: Increased work through electronic health record (EHR) messaging is frequently cited as a factor of physician burnout. However, studies to date have relied on anecdotal or self-reported measures, which limit the ability to match EHR use patterns with continuous stress patterns throughout the day. Objective: The aim of this study is to collect EHR use and physiologic stress data through unobtrusive means that provide objective and continuous measures, cluster distinct patterns of EHR inbox work, identify physicians' daily physiologic stress patterns, and evaluate the association between EHR inbox work patterns and physician physiologic stress. Methods: Physicians were recruited from 5 medical centers. Participants (N=47) were given wrist-worn devices (Garmin Vivosmart 3) with heart rate sensors to wear for 7 days. The devices measured physiological stress throughout the day based on heart rate variability (HRV). Perceived stress was also measured with self-reports through experience sampling and a one-time survey. From the EHR system logs, the time attributed to different activities was quantified. By using a clustering algorithm, distinct inbox work patterns were identified and their associated stress measures were compared. The effects of EHR use on physician stress were examined using a generalized linear mixed effects model. Results: Physicians spent an average of 1.08 hours doing EHR inbox work out of an average total EHR time of 3.5 hours. Patient messages accounted for most of the inbox work time (mean 37\%, SD 11\%). A total of 3 patterns of inbox work emerged: inbox work mostly outside work hours, inbox work mostly during work hours, and inbox work extending after hours that were mostly contiguous to work hours. Across these 3 groups, physiologic stress patterns showed 3 periods in which stress increased: in the first hour of work, early in the afternoon, and in the evening. Physicians in group 1 had the longest average stress duration during work hours (80 out of 243 min of valid HRV data; P=.02), as measured by physiological sensors. Inbox work duration, the rate of EHR window switching (moving from one screen to another), the proportion of inbox work done outside of work hours, inbox work batching, and the day of the week were each independently associated with daily stress duration (marginal R2=15\%). Individual-level random effects were significant and explained most of the variation in stress (conditional R2=98\%). Conclusions: This study is among the first to demonstrate associations between electronic inbox work and physiological stress. We identified 3 potentially modifiable factors associated with stress: EHR window switching, inbox work duration, and inbox work outside work hours. Organizations seeking to reduce physician stress may consider system-based changes to reduce EHR window switching or inbox work duration or the incorporation of inbox management time into work hours. ",
doi="10.2196/24014",
url="https://medinform.jmir.org/2021/4/e24014",
url="http://www.ncbi.nlm.nih.gov/pubmed/33908888"
}


@Article{info:doi/10.2196/23432,
author="McKeon, Grace
and Steel, Zachary
and Wells, Ruth
and Newby, Jill
and Hadzi-Pavlovic, Dusan
and Vancampfort, Davy
and Rosenbaum, Simon",
title="A Mental Health--Informed Physical Activity Intervention for First Responders and Their Partners Delivered Using Facebook: Mixed Methods Pilot Study",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="22",
volume="5",
number="4",
pages="e23432",
keywords="physical activity",
keywords="PTSD",
keywords="social media",
keywords="first responders",
keywords="mental health",
keywords="families",
keywords="online",
keywords="exercise",
abstract="Background: First responders (eg, police, firefighters, and paramedics) are at high risk of experiencing poor mental health. Physical activity interventions can help reduce symptoms and improve mental health in this group. More research is needed to evaluate accessible, low-cost methods of delivering programs. Social media may be a potential platform for delivering group-based physical activity interventions. Objective: This study aims to examine the feasibility and acceptability of delivering a mental health--informed physical activity program for first responders and their self-nominated support partners. This study also aims to assess the feasibility of applying a novel multiple time series design and to explore the impact of the intervention on mental health symptoms, sleep quality, quality of life, and physical activity levels. Methods: We co-designed a 10-week web-based physical activity program delivered via a private Facebook group. We provided education and motivation around different topics weekly (eg, goal setting, overcoming barriers to exercise, and reducing sedentary behavior) and provided participants with a Fitbit. A multiple time series design was applied to assess psychological distress levels, with participants acting as their own control before the intervention. Results: In total, 24 participants (12 first responders and 12 nominated support partners) were recruited, and 21 (88\%) completed the postassessment questionnaires. High acceptability was observed in the qualitative interviews. Exploratory analyses revealed significant reductions in psychological distress during the intervention. Preintervention and postintervention analysis showed significant improvements in quality of life (P=.001; Cohen d=0.60); total depression, anxiety, and stress scores (P=.047; Cohen d=0.35); and minutes of walking (P=.04; Cohen d=0.55). Changes in perceived social support from family (P=.07; Cohen d=0.37), friends (P=.10; Cohen d=0.38), and sleep quality (P=.28; Cohen d=0.19) were not significant. Conclusions: The results provide preliminary support for the use of social media and a multiple time series design to deliver mental health--informed physical activity interventions for first responders and their support partners. Therefore, an adequately powered trial is required. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12618001267246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001267246. ",
doi="10.2196/23432",
url="https://formative.jmir.org/2021/4/e23432",
url="http://www.ncbi.nlm.nih.gov/pubmed/33885376"
}


@Article{info:doi/10.2196/21678,
author="Hungerbuehler, Ines
and Daley, Kate
and Cavanagh, Kate
and Garcia Claro, Helo{\'i}sa
and Kapps, Michael",
title="Chatbot-Based Assessment of Employees' Mental Health: Design Process and Pilot Implementation",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="21",
volume="5",
number="4",
pages="e21678",
keywords="chatbot",
keywords="conversational agent",
keywords="online",
keywords="digital health",
keywords="mobile phone",
keywords="mental health",
keywords="workplace",
keywords="work stress",
keywords="survey",
keywords="response rate",
abstract="Background: Stress, burnout, and mental health problems such as depression and anxiety are common, and can significantly impact workplaces through absenteeism and reduced productivity. To address this issue, organizations must first understand the extent of the difficulties by mapping the mental health of their workforce. Online surveys are a cost-effective and scalable approach to achieve this but typically have low response rates, in part due to a lack of interactivity. Chatbots offer one potential solution, enhancing engagement through simulated natural human conversation and use of interactive features. Objective: The aim of this study was to explore if a text-based chatbot is a feasible approach to engage and motivate employees to complete a workplace mental health assessment. This paper describes the design process and results of a pilot implementation. Methods: A fully automated chatbot (``Viki'') was developed to evaluate employee risks of suffering from depression, anxiety, stress, insomnia, burnout, and work-related stress. Viki uses a conversation style and gamification features to enhance engagement. A cross-sectional analysis was performed to gain first insights of a pilot implementation within a small to medium--sized enterprise (120 employees). Results: The response rate was 64.2\% (77/120). In total, 98 employees started the assessment, 77 of whom (79\%) completed it. The majority of participants scored in the mild range for anxiety (20/40, 50\%) and depression (16/28, 57\%), in the moderate range for stress (10/22, 46\%), and at the subthreshold level for insomnia (14/20, 70\%) as defined by their questionnaire scores. Conclusions: A chatbot-based workplace mental health assessment seems to be a highly engaging and effective way to collect anonymized mental health data among employees with response rates comparable to those of face-to-face interviews. ",
doi="10.2196/21678",
url="https://formative.jmir.org/2021/4/e21678",
url="http://www.ncbi.nlm.nih.gov/pubmed/33881403"
}


@Article{info:doi/10.2196/19875,
author="Mamede, Andr{\'e}
and Noordzij, Gera
and Jongerling, Joran
and Snijders, Merlijn
and Schop-Etman, Astrid
and Denktas, Semiha",
title="Combining Web-Based Gamification and Physical Nudges With an App (MoveMore) to Promote Walking Breaks and Reduce Sedentary Behavior of Office Workers: Field Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="12",
volume="23",
number="4",
pages="e19875",
keywords="internet",
keywords="eHealth",
keywords="mHealth",
keywords="mobile phone",
keywords="lifestyle",
keywords="obesity",
keywords="social network",
keywords="multilevel analysis",
keywords="physical exercise",
abstract="Background: Sedentary behavior (SB) and lack of physical activity (PA) have been associated with poorer health outcomes and are increasingly prevalent in individuals working in sedentary occupations such as office jobs. Gamification and nudges have attracted attention as promising strategies to promote changes in health behavior. However, most effectiveness studies thus far lacked active controls, and few studies have tested interventions combining these strategies. Objective: This study investigates the effectiveness of combining a gamified digital app with physical nudges to increase PA and reduce SB in Dutch office workers. Methods: Employees in the municipality of Rotterdam (N=298) from two office locations were randomized at the location level to either a 10-week intervention, combining a 5-week gamification phase encompassing a gamified digital app with social support features and a 5-week physical nudges phase, or to an active control (ie, basic digital app with self-monitoring and goal setting). The primary outcome was the daily step count, objectively measured via accelerometers. Secondary outcomes were self-reported PA and SB measured at baseline and at 5, 10, and 14 weeks. Mixed effects models were used to analyze the effects of the intervention on the outcome measures. Results: A total of 78.5\% (234/298) of participants completed the study and provided accelerometer data, whereas 36.9\% (110/298) participants completed the self-report measures at 14 weeks. In the gamification phase, step count data were missing for 13.5\% (473/3492) of observations in the control and 11.4\% (445/3888) in the intervention condition; however, these percentages increased to 39.6\% (1154/2910) and 59.6\% (1932/3492) at follow-up, respectively. During the gamification phase, intervention participants increased their number of daily steps by 634 (95\% CI 154.2-1113.8; P=.01) more than participants in the control group, after controlling for relevant factors. Improvements were not sustained during the physical nudges phase (P=.76) or follow-up (P=.88). Conclusions: A digital intervention with gamification and social support features significantly increased the step count of office workers compared with an active control. Physical nudges in the workplace were insufficient to promote the maintenance of behavioral changes achieved in the gamification phase. Future research should explore the long-term effectiveness of similar gamified digital interventions. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 49129401; https://www.isrctn.com/ISRCTN14881571 ",
doi="10.2196/19875",
url="https://www.jmir.org/2021/4/e19875",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843593"
}


@Article{info:doi/10.2196/27121,
author="Banholzer, Nicolas
and Feuerriegel, Stefan
and Fleisch, Elgar
and Bauer, Friedrich Georg
and Kowatsch, Tobias",
title="Computer Mouse Movements as an Indicator of Work Stress: Longitudinal Observational Field Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="2",
volume="23",
number="4",
pages="e27121",
keywords="work stress",
keywords="psychological stress",
keywords="stress indicator",
keywords="computer mouse movements",
keywords="human-computer interactions",
abstract="Background: Work stress affects individual health and well-being. These negative effects could be mitigated through regular monitoring of employees' stress. Such monitoring becomes even more important as the digital transformation of the economy implies profound changes in working conditions. Objective: The goal of this study was to investigate the association between computer mouse movements and work stress in the field. Methods: We hypothesized that stress is associated with a speed-accuracy trade-off in computer mouse movements. To test this hypothesis, we conducted a longitudinal field study at a large business organization, where computer mouse movements from regular work activities were monitored over 7 weeks; the study included 70 subjects and 1829 observations. A Bayesian regression model was used to estimate whether self-reported acute work stress was associated with a speed-accuracy trade-off in computer mouse movements. Results: There was a negative association between stress and the two-way interaction term of mouse speed and accuracy (mean ?0.32, 95\% highest posterior density interval ?0.58 to ?0.08), which means that stress was associated with a speed-accuracy trade-off. The estimated association was not sensitive to different processing of the data and remained negative after controlling for the demographics, health, and personality traits of subjects. Conclusions: Self-reported acute stress is associated with computer mouse movements, specifically in the form of a speed-accuracy trade-off. This finding suggests that the regular analysis of computer mouse movements could indicate work stress. ",
doi="10.2196/27121",
url="https://www.jmir.org/2021/4/e27121",
url="http://www.ncbi.nlm.nih.gov/pubmed/33632675"
}


@Article{info:doi/10.2196/21917,
author="Javanmard, Mitra
and Steen, Mary
and Vernon, Rachael",
title="Influence of Self-Compassion on the Health of Midwives and Nurses: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="31",
volume="10",
number="3",
pages="e21917",
keywords="self-compassion",
keywords="self-worth",
keywords="self-appreciation",
keywords="self-kindness",
keywords="midwives",
keywords="nurses",
abstract="Background: Self-compassion is recognized to have a positive effect upon a person's health. However, the influence of self-compassion on the health of midwives and nurses is less well understood. Midwives and nurses often work in highly demanding environments and situations, and are exposed to multiple work-based stressors simultaneously. Stressors such as a demanding clinical workload, high acuity, missing breaks, working more than their contracted hours, insufficient resources and staff, and poor patient outcomes can lead to midwives and nurses feeling physically exhausted and at increased risk of poor mental health. Self-compassion may act as a protective factor, assisting midwives and nurses to remain healthy. Objective: This scoping review will provide an overview of the evidence base relating to the influence of self-compassion on the health of midwives and nurses. Methods: The purpose of a scoping review is to comprehensively and systematically review the literature and identify key evidence or gaps. The search strategy for this protocol includes electronic databases such as Medline, Embase, Emcare, PsycInfo, Joanna Briggs Institute, Cochrane Library, and Scopus. Grey literature sources will be also searched, including ProQuest Central, internet search engines (Google Scholar), and manually searched key journals and reference lists of relevant articles. This scoping review will be undertaken in seven stages, guided by established scoping review methods and reporting guidelines: (1) identifying the research questions; (2) identifying relevant studies; (3) selecting the studies; (4) charting the data; (5) collating, summarizing, and reporting the results; (6) consulting; and (7) dissemination of knowledge. Data will be abstracted and presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and explanation by three independent researchers. Results: A preliminary search conducted in Medline (OVID) retrieved 194 results. Completion of the review is expected in December 2020 and will be published in early 2021. Conclusions: To our knowledge, this will be the first scoping review of evidence-based literature relating to the influence of self-compassion on the health of midwives and nurses. It is anticipated that this analysis of the literature will contribute to understanding how midwives and nurses may use self-compassion in a proactive way to reduce work-based stressors such as burnout, stress, and compassion fatigue. Furthermore, the findings may inform educational needs with implications for clinical practice. International Registered Report Identifier (IRRID): PRR1-10.2196/21917 ",
doi="10.2196/21917",
url="https://www.researchprotocols.org/2021/3/e21917",
url="http://www.ncbi.nlm.nih.gov/pubmed/33787500"
}


@Article{info:doi/10.2196/22099,
author="Hwang, Youjin
and Shin, Donghoon
and Eun, Jinsu
and Suh, Bongwon
and Lee, Joonhwan",
title="Design Guidelines of a Computer-Based Intervention for Computer Vision Syndrome: Focus Group Study and Real-World Deployment",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="29",
volume="23",
number="3",
pages="e22099",
keywords="computer-based intervention",
keywords="computer vision syndrome",
keywords="system interface",
keywords="deployment study",
abstract="Background: Prolonged time of computer use increases the prevalence of ocular problems, including eye strain, tired eyes, irritation, redness, blurred vision, and double vision, which are collectively referred to as computer vision syndrome (CVS). Approximately 70\% of computer users have vision-related problems. For these reasons, properly designed interventions for users with CVS are required. To design an effective screen intervention for preventing or improving CVS, we must understand the effective interfaces of computer-based interventions. Objective: In this study, we aimed to explore the interface elements of computer-based interventions for CVS to set design guidelines based on the pros and cons of each interface element. Methods: We conducted an iterative user study to achieve our research objective. First, we conducted a workshop to evaluate the overall interface elements that were included in previous systems for CVS (n=7). Through the workshop, participants evaluated existing interface elements. Based on the evaluation results, we eliminated the elements that negatively affect intervention outcomes. Second, we designed our prototype system LiquidEye that includes multiple interface options (n=11). Interface options included interface elements that were positively evaluated in the workshop study. Lastly, we deployed LiquidEye in the real world to see how the included elements affected the intervention outcomes. Participants used LiquidEye for 14 days, and during this period, we collected participants' daily logs (n=680). Additionally, we conducted prestudy and poststudy surveys, and poststudy interviews to explore how each interface element affects participation in the system. Results: User data logs collected from the 14 days of deployment were analyzed with multiple regression analysis to explore the interface elements affecting user participation in the intervention (LiquidEye). Statistically significant elements were the instruction page of the eye resting strategy (P=.01), goal setting of the resting period (P=.009), compliment feedback after completing resting (P<.001), a mid-size popup window (P=.02), and CVS symptom-like effects (P=.004). Conclusions: Based on the study results, we suggested design implications to consider when designing computer-based interventions for CVS. The sophisticated design of the customization interface can make it possible for users to use the system more interactively, which can result in higher engagement in managing eye conditions. There are important technical challenges that still need to be addressed, but given the fact that this study was able to clarify the various factors related to computer-based interventions, the findings are expected to contribute greatly to the research of various computer-based intervention designs in the future. ",
doi="10.2196/22099",
url="https://www.jmir.org/2021/3/e22099",
url="http://www.ncbi.nlm.nih.gov/pubmed/33779568"
}


@Article{info:doi/10.2196/24323,
author="Tran, Kim-Anh
and Pollock, William Neal
and Rh{\'e}aume, Caroline
and Razdan, Sonya Payal
and Fortier, F{\'e}lix-Antoine
and Dutil-Fafard, Lara
and Morin, Camille
and Monnot, Pierre-Marie David
and Huot-Lavoie, Maxime
and Simard-Sauriol, Philippe
and Chandavong, Sam
and Le Pabic, Genevi{\`e}ve
and LeBlanc, Jean-Philippe
and Lafond, Daniel
and Marion, Andr{\'e}anne
and Archambault, Michel Patrick",
title="Evidence Supporting the Management of Medical Conditions During Long-Duration Spaceflight: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="29",
volume="10",
number="3",
pages="e24323",
keywords="spaceflight",
keywords="astronauts",
keywords="microgravity",
keywords="weightlessness",
keywords="acute coronary syndrome",
keywords="arrhythmia",
keywords="atrial fibrillation",
keywords="eye penetration",
keywords="intraocular foreign body",
keywords="herniated disk",
keywords="nephrolithiasis",
keywords="pulmonary embolism",
keywords="retinal detachment",
keywords="sepsis",
keywords="stroke",
keywords="spaceflight associated neuro-ocular syndrome",
abstract="Background: Future long-duration space exploration missions, such as traveling to Mars, will create an increase in communication time delays and disruptions and remove the viability of emergency returns to Earth for timely medical treatment. Thus, higher levels of medical autonomy are necessary. Crew selection is proposed as the first line of defense to minimize medical risk for future missions; however, the second proposed line of defense is medical preparedness and crew member autonomy. In an effort to develop a decision support system, the Canadian Space Agency mandated a team of scientists from Thales Research and Technology Canada (Qu{\'e}bec, QC) and Universit{\'e} Laval (Qu{\'e}bec, QC) to create an evidence-based medical condition database linking mission-critical human conditions with key causal factors, diagnostic and treatment information, and probable outcomes. Objective: To complement this database, we are currently conducting a scoping review to better understand the depth and breadth of evidence about managing medical conditions in space. Methods: This scoping review will adhere to quality standards for scoping reviews, employing Levac, Colquhoun, and O'Brien's 6-stage methodology; the reported results will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. In stage 1, we identified the research question in collaboration with the Canadian Space Agency (CSA), the main knowledge user. We prioritized 10 medical conditions: (1) acute coronary syndrome, (2) atrial fibrillation, (3) eye penetration, (4) herniated disk, (5) nephrolithiasis, (6) pulmonary embolism, (7) retinal detachment, (8) sepsis, (9) stroke, and (10) spaceflight associated neuro-ocular syndrome. In stage 2, with the help of an information specialist from Cochrane Canada Francophone, papers were identified through searches of the following databases: ARC, Embase, IeeeXplore, Medline Ovid, PsychINFO, and Web of Science. In stage 3, studies will be selected and assessed using a 3-step process and emerging, refined exclusion criteria. In stage 4, the data will be charted in a table based on parameters required by the CSA and developed using Google spreadsheets for shared access. In stage 5, evidence-based descriptive summaries will be produced for each condition, as well as descriptive analyses of collected data. Finally, in stage 6, the findings will be shared with the CSA to guide the completion of this project. Results: This study was planned in December 2018. Stage 1 has been completed. The initial database search strategy with all target conditions combined identified a total of 10,403 citations to review through title and abstract screening and after duplicate removal. We plan to complete stages 2-6 by the beginning of 2021. Conclusions: This scoping review will map the literature on the management of 10 priority medical conditions in space. It will also enable us to identify knowledge gaps that must be addressed in future research, ensuring successful and medically safe future missions as humankind embarks upon new frontiers of space exploration. International Registered Report Identifier (IRRID): DERR1-10.2196/24323 ",
doi="10.2196/24323",
url="https://www.researchprotocols.org/2021/3/e24323",
url="http://www.ncbi.nlm.nih.gov/pubmed/33779571"
}


@Article{info:doi/10.2196/24799,
author="Ito-Masui, Asami
and Kawamoto, Eiji
and Sakamoto, Ryota
and Yu, Han
and Sano, Akane
and Motomura, Eishi
and Tanii, Hisashi
and Sakano, Shoko
and Esumi, Ryo
and Imai, Hiroshi
and Shimaoka, Motomu",
title="Internet-Based Individualized Cognitive Behavioral Therapy for Shift Work Sleep Disorder Empowered by Well-Being Prediction: Protocol for a Pilot Study",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="18",
volume="10",
number="3",
pages="e24799",
keywords="shift work sleep disorders",
keywords="health care workers",
keywords="wearable sensors",
keywords="shift work",
keywords="sleep disorder",
keywords="medical safety",
keywords="safety issue",
keywords="shift workers",
keywords="sleep",
keywords="safety",
keywords="cognitive behavioral therapy",
keywords="CBT",
keywords="online intervention",
keywords="pilot study",
keywords="machine learning",
keywords="well-being",
abstract="Background: Shift work sleep disorders (SWSDs) are associated with the high turnover rates of nurses, and are considered a major medical safety issue. However, initial management can be hampered by insufficient awareness. In recent years, it has become possible to visualize, collect, and analyze the work-life balance of health care workers with irregular sleeping and working habits using wearable sensors that can continuously monitor biometric data under real-life settings. In addition, internet-based cognitive behavioral therapy for psychiatric disorders has been shown to be effective. Application of wearable sensors and machine learning may potentially enhance the beneficial effects of internet-based cognitive behavioral therapy. Objective: In this study, we aim to develop and evaluate the effect of a new internet-based cognitive behavioral therapy for SWSD (iCBTS). This system includes current methods such as medical sleep advice, as well as machine learning well-being prediction to improve the sleep durations of shift workers and prevent declines in their well-being. Methods: This study consists of two phases: (1) preliminary data collection and machine learning for well-being prediction; (2) intervention and evaluation of iCBTS for SWSD. Shift workers in the intensive care unit at Mie University Hospital will wear a wearable sensor that collects biometric data and answer daily questionnaires regarding their well-being. They will subsequently be provided with an iCBTS app for 4 weeks. Sleep and well-being measurements between baseline and the intervention period will be compared. Results: Recruitment for phase 1 ended in October 2019. Recruitment for phase 2 has started in October 2020. Preliminary results are expected to be available by summer 2021. Conclusions: iCBTS empowered with well-being prediction is expected to improve the sleep durations of shift workers, thereby enhancing their overall well-being. Findings of this study will reveal the potential of this system for improving sleep disorders among shift workers. Trial Registration: UMIN Clinical Trials Registry UMIN000036122 (phase 1), UMIN000040547 (phase 2); https://tinyurl.com/dkfmmmje, https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000046284 International Registered Report Identifier (IRRID): DERR1-10.2196/24799 ",
doi="10.2196/24799",
url="https://www.researchprotocols.org/2021/3/e24799",
url="http://www.ncbi.nlm.nih.gov/pubmed/33626497"
}


@Article{info:doi/10.2196/25148,
author="Otokiti, Umar Ahmed
and Craven, K. Catherine
and Shetreat-Klein, Avniel
and Cohen, Stacey
and Darrow, Bruce",
title="Beyond Getting Rid of Stupid Stuff in the Electronic Health Record (Beyond-GROSS): Protocol for a User-Centered, Mixed-Method Intervention to Improve the Electronic Health Record System",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="16",
volume="10",
number="3",
pages="e25148",
keywords="electronic health records",
keywords="burnout, psychological",
keywords="user-centered design",
keywords="usability",
keywords="EHR optimization",
abstract="Background: Up to 60\% of health care providers experience one or more symptoms of burnout. Perceived clinician burden resulting in burnout arises from factors such as electronic health record (EHR) usability or lack thereof, perceived loss of autonomy, and documentation burden leading to less clinical time with patients. Burnout can have detrimental effects on health care quality and contributes to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide. Objective: This project aims to improve the user-centered design of the EHR by obtaining direct input from clinicians about deficiencies. Fixing identified deficiencies via user-centered design has the potential to improve usability, thereby increasing satisfaction by reducing EHR-induced burnout. Methods: Quantitative and qualitative data will be obtained from clinician EHR users. The input will be received through a form built in a REDCap database via a link embedded in the home page of the EHR. The REDCap data will be analyzed in 2 main dimensions, based on nature of the input, what section of the EHR is affected, and what is required to fix the issue(s). Identified issues will be escalated to relevant stakeholders responsible for rectifying the problems identified. Data analysis, project evaluation, and lessons learned from the evaluation will be incorporated in a Plan-Do-Study-Act (PDSA) manner every 4-6 weeks. Results: The pilot phase of the study began in October 2020 in the Gastroenterology Division at Mount Sinai Hospital, New York City, NY, which includes 39 physicians and 15 nurses. The pilot is expected to run over a 4-6--month period. The results of the REDCap data analysis will be reported within 1 month of completing the pilot phase. We will analyze the nature of requests received and the impact of rectified issues on the clinician EHR user. We expect that the results will reveal which sections of the EHR have the highest deficiencies while also highlighting issues about workflow difficulties. Perceived impact of the project on provider engagement, patient safety, and workflow efficiency will also be captured by evaluation survey and other qualitative methods where possible. Conclusions: The project aims to improve user-centered design of the EHR by soliciting direct input from clinician EHR users. The ultimate goal is to improve efficiency, reduce EHR inefficiencies with the possibility of improving staff engagement, and lessen EHR-induced clinician burnout. Our project implementation includes using informatics expertise to achieve the desired state of a learning health system as recommended by the National Academy of Medicine as we facilitate feedback loops and rapid cycles of improvement. International Registered Report Identifier (IRRID): PRR1-10.2196/25148 ",
doi="10.2196/25148",
url="https://www.researchprotocols.org/2021/3/e25148",
url="http://www.ncbi.nlm.nih.gov/pubmed/33724202"
}


@Article{info:doi/10.2196/24906,
author="Bregenzer, Anita
and Jimenez, Paulino",
title="Risk Factors and Leadership in a Digitalized Working World and Their Effects on Employees' Stress and Resources: Web-Based Questionnaire Study",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="12",
volume="23",
number="3",
pages="e24906",
keywords="digitalization",
keywords="leadership",
keywords="new ways of working",
keywords="resources",
keywords="stress",
abstract="Background: In today's world of work, the digitalization of work and communication processes is increasing, and will increase even further. This increase in digitalization at the workplace brings many new aspects of working life to light, such as working in virtual teams, mobile working, expectations of being constantly available, and the need for support in adapting and learning new digital tools. These changes to the workplace can contain risks that might harm the well-being of employees. Leaders can support the well-being of their employees in terms of protecting and replenishing their work-related resources to cope with critical work demands. This so-called health-promoting leadership could serve as a buffer between risk at the workplace and critical outcomes, such as stress, by amplifying work-related resources. Objective: This study's aims were twofold. First, we wanted to investigate if risk factors related to higher digitalization at the workplace can be identified and if these risk factors have an impairing effect on the well-being of employees (eg, higher stress and lower resources). Second, we wanted to investigate if the health-impairing effects of these risk factors can be reduced by health-promoting leadership. Methods: A total of 1412 employees from Austria, Germany, and Switzerland took part in this online study and provided information on their perceived risks at the workplace, their leaders' health-promoting behaviors, and their work-related stress and resources. Results: The results of a hierarchical regression analysis showed that all four risk factors of digital work (distributed team work, mobile work, constant availability, and inefficient technical support) were related to higher stress at the workplace. In addition, distributed team work and inefficient technical support were associated with lower work-related resources. A possible buffer effect of health-promoting leadership between these risks and employee well-being was visible for inefficient technical support. In particular, in the case of having fewer support opportunities in learning and using digital tools, leaders could weaken the potential critical effects on stress. As for the other risk factors, leaders might engage in a different leadership behavior to improve their employees' well-being, as the physical distance between leaders and employees in virtual team work or mobile work could make health-promoting leadership more difficult. Conclusions: In a digitalized working world, solutions are needed to create working conditions that benefit employees. The results of this study strongly support the importance of investigating risk factors associated with an increase in digitalization at the workplace in addition to traditional risk factors. As for leadership, leaders need to show leadership behavior adapted to a digitalized workplace in order to reduce employee stress and increase work-related resources. ",
doi="10.2196/24906",
url="https://www.jmir.org/2021/3/e24906",
url="http://www.ncbi.nlm.nih.gov/pubmed/33709933"
}


@Article{info:doi/10.2196/20445,
author="Sasaki, Natsu
and Imamura, Kotaro
and Tran, Thu Thuy Thi
and Nguyen, Thanh Huong
and Kuribayashi, Kazuto
and Sakuraya, Asuka
and Bui, Minh Thu
and Nguyen, Thuy Quynh
and Nguyen, Thi Nga
and Nguyen, Huong Giang Thi
and Zhang, Weibin Melvyn
and Minas, Harry
and Sekiya, Yuki
and Watanabe, Kazuhiro
and Tsutsumi, Akizumi
and Shimazu, Akihito
and Kawakami, Norito",
title="Effects of Smartphone-Based Stress Management on Improving Work Engagement Among Nurses in Vietnam: Secondary Analysis of a Three-Arm Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="23",
volume="23",
number="2",
pages="e20445",
keywords="stress management",
keywords="mental health",
keywords="occupational health",
keywords="digital health",
keywords="workplace",
keywords="LMICs",
keywords="South-East Asia",
keywords="health care professionals",
abstract="Background: Work engagement is important for employee well-being and work performance. However, no intervention study has investigated the effect of an eMental Health intervention on work engagement among workers in low- and middle-income countries (LMICs). Objective: The aim of the study was to examine the effects of a newly developed smartphone-based stress management program (ABC Stress Management) on improving work engagement among hospital nurses in Vietnam, an LMIC. Methods: Full-time registered nurses (n=949) were randomly assigned to one of 2 intervention groups or a control group. The intervention groups were a 6-week, 6-lesson program offering basic cognitive behavioral therapy (CBT-based stress management skills), provided in either free-choice (program A) or fixed order (program B). Work engagement was assessed at baseline and 3-month and 7-month follow-ups in each of the 3 groups. Results: The scores of work engagement in both intervention groups improved from baseline to 3-month follow-up, and then decreased at the 7-month follow-up, while the score steadily increased from baseline to 7-month follow-up in the control group. Program B showed a significant intervention effect on improving work engagement at the 3-month follow-up (P=.049) with a small effect size (Cohen d= 0.16; 95\% CI 0.001 to 0.43]). Program A showed nonsignificant trend (d=0.13; 95\% CI --0.014 to 0.41; P=.07) toward improved engagement at 3 months. Neither program achieved effectiveness at the 7-month follow-up. Conclusions: The study demonstrated that a fixed order (program B) delivery of a smartphone-based stress management program was effective in improving work engagement in nurses in Vietnam. However, the effect was small and only temporary. Further improvement of this program is required to achieve a greater effect size and more sustained, longer lasting impact on work engagement. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000033139; tinyurl.com/55gxo253 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025138 ",
doi="10.2196/20445",
url="https://www.jmir.org/2021/2/e20445",
url="http://www.ncbi.nlm.nih.gov/pubmed/33620328"
}


@Article{info:doi/10.2196/24392,
author="Hannerz, Harald
and Burr, Hermann
and Soll-Johanning, Helle
and Nielsen, Lindhardt Martin
and Garde, Helene Anne
and Flyvholm, Mari-Ann",
title="Prospective Associations Between Fixed-Term Contract Positions and Mental Illness Rates in Denmark's General Workforce: Protocol for a Cohort Study",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="5",
volume="10",
number="2",
pages="e24392",
keywords="cohort study",
keywords="fixed-term employment",
keywords="fixed term contract",
keywords="unemployment",
keywords="psychotropic drugs",
keywords="psychiatric hospital treatment",
abstract="Background: In 2018, 14\% of employees in the European Union had fixed-term contracts. Fixed-term contract positions are often less secure than permanent contract positions. Perceived job insecurity has been associated with increased rates of mental ill health. However, the association between fixed-term contract positions and mental ill health is uncertain. A recent review concluded that the quality of most existing studies is low and that the results of the few studies with high quality are contradictory. Objective: This study aims to estimate the incidence rate ratios (RRs) of psychotropic drug use and psychiatric hospital treatment. These ratios will be considered, first, in relation to the contrast fixed-term versus permanent contract and, second, to fixed-term contract versus unemployment. Methods: Interview data with baseline information on employment status from the Danish Labor Force Surveys in the years 2001-2013 will be linked to data from national registers. Participants will be followed up for up to 5 years after the interview. Poisson regression will be used to estimate incidence RRs for psychiatric hospital treatment for mood, anxiety, or stress-related disorders and redeemed prescriptions for psychotropic drugs, as a function of employment status at baseline. The following contrasts will be considered: full-time temporary employment versus full-time permanent employment and temporary employment (regardless of weekly working hours) versus unemployment. The analyses will be controlled for a series of possible confounders. People who have received sickness benefits, have received social security cash benefits, have redeemed a prescription for psychotropic drugs, or have received psychiatric hospital treatment for a mental disorder sometime during a 1-year period preceding baseline will be excluded from the study. The study will include approximately 134,000 participants (13,000 unemployed, 106,000 with permanent contracts, and 15,000 with fixed-term contracts). We expect to find approximately 16,400 incident cases of redeemed prescriptions of psychotropic drugs and 2150 incident cases of psychiatric hospital treatment for mood, anxiety, or stress-related disorders. Results: We expect the analyses to be completed by the end of 2021 and the results to be published in mid-2022. Conclusions: The statistical power of the study will be large enough to test the hypothesis of a prospective association between fixed-term contract positions and mental illness in the general workforce of Denmark. International Registered Report Identifier (IRRID): DERR1-10.2196/24392 ",
doi="10.2196/24392",
url="https://www.researchprotocols.org/2021/2/e24392",
url="http://www.ncbi.nlm.nih.gov/pubmed/33325837"
}


@Article{info:doi/10.2196/23623,
author="Kaihlanen, Anu-Marja
and Gluschkoff, Kia
and Hypp{\"o}nen, Hannele
and Kaipio, Johanna
and Puttonen, Sampsa
and Vehko, Tuulikki
and Saranto, Kaija
and Karhe, Liisa
and Heponiemi, Tarja",
title="The Associations of Electronic Health Record Usability and User Age With Stress and Cognitive Failures Among Finnish Registered Nurses: Cross-Sectional Study",
journal="JMIR Med Inform",
year="2020",
month="Nov",
day="18",
volume="8",
number="11",
pages="e23623",
keywords="electronic health records",
keywords="usability",
keywords="stress",
keywords="cognitive failure",
keywords="nurse",
abstract="Background: Electronic health records (EHRs) are expected to provide many clinical and organizational benefits. Simultaneously, the end users may face unintended consequences, such as stress and increased cognitive workload, due to poor EHR usability. However, whether the effects of usability depend on end user characteristics, such as career stage or age, remains poorly understood. Objective: The objective of this study was to examine the associations of EHR usability and user age with stress related to information systems and cognitive failures among registered nurses. Methods: A cross-sectional survey design was employed in Finland in 2017. A total of 3383 registered nurses responded to the nationwide electronic survey. Multiple linear regression was used to examine the associations of EHR usability (eg, how easily information can be found and a patient's care can be documented) and user age with stress related to information systems and cognitive failures. Interaction effects of EHR usability and age were also tested. Models were adjusted for gender and employment sector. Results: Poor EHR usability was associated with higher levels of stress related to information systems ($\beta$=.38; P<.001). The strength of the association did not depend on user age. Poor EHR usability was also associated with higher levels of cognitive failures ($\beta$=.28; P<.001). There was a significant interaction effect between age and EHR usability for cognitive failures ($\beta$=.04; P<.001). Young nurses who found the EHR difficult to use reported the most cognitive failures. Conclusions: Information system stress due to poor EHR usability afflicts younger and older nurses alike. However, younger nurses starting their careers may be more cognitively burdened if they find EHR systems difficult to use compared to older nurses. Adequate support in using the EHRs may be particularly important to young registered nurses, who have a lot to learn and adopt in their early years of practice. ",
doi="10.2196/23623",
url="http://medinform.jmir.org/2020/11/e23623/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33206050"
}


@Article{info:doi/10.2196/16376,
author="Yan, Xinghui
and Rau, Patrick Pei-Luen
and Zhong, Runting",
title="Leveraging Walking Performance to Understand Work Fatigue Among Young Adults: Mixed-Methods Study",
journal="Interact J Med Res",
year="2020",
month="Nov",
day="13",
volume="9",
number="4",
pages="e16376",
keywords="work fatigue",
keywords="fatigability",
keywords="walking performance",
keywords="6MWT",
keywords="mobile health",
abstract="Background: Work fatigue negatively impacts personal health in the long term. Prior research has indicated the possibility of leveraging both walking parameters and perceptual measures to assess a person's fatigue status. However, an effective and ubiquitous approach to assessing work fatigue in young adults remains unexplored. Objective: The goals of this paper were to (1) explore how walking rhythms and multiple streams of data, including reaction time, self-reports, and an activity diary, reflect work-induced fatigue in the lab setting; (2) identify the relationship between objective performance and subjective perception in indicating fatigue status and fatigability; and (3) propose a mobile-based assessment for work-induced fatigue that uses multiple measurements. Methods: We conducted a 2-day in-lab study to measure participants' fatigue status using multiple measurements, including the stair climb test (SCT), the 6-minute walk test (6MWT), and the reaction time test. Both the SCT and the 6MWT were conducted at different points in time and under 2 conditions (measurement time, including prior to and after work, and pace, including normal and fast). Participants reported their fatigue perception through questionnaires completed before conducting walking tests and in an activity diary recorded over a week. Walking performance data were collected by a smartphone with a built-in 3-axis accelerometer. To examine the effect of fatigability on walking performance, we first clustered participants into 2 groups based on their reported mental fatigue level in the entry surveys and then compared their walking performance using a generalized linear model (GLM). The reaction time was examined using a 2-way repeated-measures GLM. We conducted semistructured interviews to understand participants' fatigue perception after each day's walking tests. Results: All participants (N=26; mean age 24.68 years) were divided into 2 groups---the fatigue-sensitive group (11/26, 42\%) and the fatigue-nonsensitive group (15/26, 58\%)---based on their mental subscores from 3 entry surveys: Fatigue Scale-14, Three-Dimensional Work Fatigue Inventory, and Fatigue Self-Assessment Scale (FSAS). The fatigue-sensitive group reported a significantly higher FSAS score in the before-work setting (t50=--3.361; P=.001). The fatigue-sensitive group covered fewer steps than the fatigue-nonsensitive group ($\beta$1=--0.099; SE 0.019; t1=--5.323; P<.001) and had a higher step-to-step time variability in the 6MWT ($\beta$1=9.61 {\texttimes} 10--4; t1=2.329; P=.02). No strong correlation between subjective and objective measurements was observed in the study. Conclusions: Walking parameters, including step counts and step-to-step time variability, and some selected scales (eg, FSAS) were found to reflect participants' work-induced fatigue. Overall, our work suggests the opportunity of employing mobile-based walking measurements to indicate work fatigue among young adults. ",
doi="10.2196/16376",
url="http://www.i-jmr.org/2020/4/e16376/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33185557"
}


@Article{info:doi/10.2196/18067,
author="Kawadler, M. Jamie
and Hemmings, Rose Nicola
and Ponzo, Sonia
and Morelli, Davide
and Bird, Geoffrey
and Plans, David",
title="Effectiveness of a Smartphone App (BioBase) for Reducing Anxiety and Increasing Mental Well-Being: Pilot Feasibility and Acceptability Study",
journal="JMIR Form Res",
year="2020",
month="Nov",
day="10",
volume="4",
number="11",
pages="e18067",
keywords="health and well-being",
keywords="health promotion",
keywords="organizational and leadership support",
keywords="workplace",
abstract="Background: The prevalence of workplace-related stress and anxiety is high, resulting in stress-related physical and mental illness. Digital self-guided interventions aimed at key areas of workplace design may be able to provide remote anxiolytic effects. Objective: The aim of this feasibility study is to assess changes in anxiety and mental well-being after use of the BioBase programme, a mobile phone platform for psycho-educational modules, tools, and real-time feedback of physiological data. Methods: A 4-week observational study was carried out in 55 healthy adults who were screened for stress with the Depression Anxiety Stress Scale (DASS) Stress subscale. Participants completed anxiety (6-item State-Trait Anxiety Inventory [STAI]) and mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) questionnaires at baseline and at 4 weeks. Feedback questionnaires were administered after 4 weeks. Results: After 4 weeks of using the programme and controlling for any effect of being paid to take part in the study, STAI significantly decreased (baseline mean 45.52 [SD 13.2]; 4-week mean 39.82 [SD 11.2]; t54=--3.51; P<.001; CI --8.88 to --2.52; Cohen d=0.96) and WEMWBS significantly increased (baseline mean 48.12 [SD 6.4]; 4-week mean 50.4 [SD 6.9]; t53=2.41; P=.019; CI 0.44-4.23; Cohen d=0.66). Further, higher baseline stress was significantly associated with a greater decrease in STAI (t53=--3.41; P=.001; CI --8.10 to --2.10; R2=0.180) and a greater increase in WEMWBS (t52=2.41; P=.019; CI 0.38-4.11, R2=0.101). On feedback, participants found the programme easy to use/navigate, with the content being acceptable and relevant to workplace-related stressors; 70\% (21/30) of participants would recommend the programme to a friend. Conclusions: The BioBase programme is a potentially effective intervention in decreasing anxiety and increasing mental well-being, with larger changes in those with higher baseline levels of stress. ",
doi="10.2196/18067",
url="https://formative.jmir.org/2020/11/e18067",
url="http://www.ncbi.nlm.nih.gov/pubmed/32969341"
}


@Article{info:doi/10.2196/19412,
author="Chelidoni, Olga
and Plans, David
and Ponzo, Sonia
and Morelli, Davide
and Cropley, Mark",
title="Exploring the Effects of a Brief Biofeedback Breathing Session Delivered Through the BioBase App in Facilitating Employee Stress Recovery: Randomized Experimental Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="15",
volume="8",
number="10",
pages="e19412",
keywords="breathing",
keywords="biofeedback",
keywords="smartphone",
keywords="heart rate variability",
keywords="recovery",
keywords="mindfulness",
keywords="stress",
keywords="mobile phone",
abstract="Background: Recovery from stress is a predictive factor for cardiovascular health, and heart rate variability (HRV) is suggested to be an index of how well people physiologically recover from stress. Biofeedback and mindfulness interventions that include guided breathing have been shown to be effective in increasing HRV and facilitating stress recovery. Objective: This study aims to assess the effectiveness of a brief app-based breathing intervention (BioBase) in enhancing physiological recovery among employees who were induced to cognitive and emotional stress. Methods: In total, we recruited 75 full-time employees. Interbeat (RR) intervals were recorded continuously for 5 min at baseline and during cognitive and emotional stress induction. The session ended with a 5-min recovery period during which participants were randomly allocated into 3 conditions: app-based breathing (BioBase), mindfulness body scan, or control. Subjective tension was assessed at the end of each period. Results: Subjective tension significantly increased following stress induction. HRV significantly decreased following the stress period. In the recovery phase, the root mean square of successive RR interval differences (P=.002), the percentage of successive RR intervals that differed by >50 ms (P=.008), and high frequency (P=.01) were significantly higher in the BioBase breathing condition than in the mindfulness body scan and the control groups. Conclusions: Biofeedback breathing interventions digitally delivered through a commercially available app can be effective in facilitating stress recovery among employees. These findings contribute to the mobile health literature on the beneficial effects of brief app-based breathing interventions on employees' cardiovascular health. ",
doi="10.2196/19412",
url="http://mhealth.jmir.org/2020/10/e19412/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33055072"
}


@Article{info:doi/10.2196/17835,
author="Leary, Miriam
and Thomas, James
and Hayes, Ryan
and Sherlock, Lori",
title="Evaluation of an Occupational Exercise Training Program for Firefighters: Mixed Methods Pilot Study",
journal="JMIR Form Res",
year="2020",
month="Sep",
day="21",
volume="4",
number="9",
pages="e17835",
keywords="firefighters",
keywords="exercise",
keywords="mixed methods",
keywords="qualitative",
keywords="clinical",
keywords="performance",
abstract="Background: Occupational exercise training programs can improve overall health and fitness in firefighters, but evidence beyond clinical and performance outcomes is needed before fire departments invest in and successfully adopt health promotion programs. Objective: This mixed methods pilot study sought to pair clinical and performance outcomes with participants' qualitative feedback (eg, participants' enjoyment, lifestyle behavior changes, and team structure) with the goal of informing recommendations for future programs. Methods: Professional firefighters participated in a 14-week occupational exercise training program with assessments conducted pre- and posttraining. Clinical outcomes included weight, BMI, body fat percentage, resting heart rate, systolic blood pressure, and diastolic blood pressure. Performance outcomes included the sharpened Romberg balance test, 1-repetition maximum leg press and bench press, graded exercise test (estimated VO2max), knee range of motion, shoulder flexibility, and hamstring flexibility. Self-administered surveys (Short Form-36, International Physical Activity Questionnaire, Barriers Self-Efficacy Scale, and Barriers to Being Active Quiz) were completed. In 3 private focus groups of 3 to 4 participants, firefighters' experiences in the training program and their health behaviors were explored. Results: Male firefighters (n=14; age: mean 36.4, SD 2.6 years) completed 20 training sessions. There were no significant changes to weight (P=.20), BMI (P=.15), body fat percentage (P=.16), systolic blood pressure (P=.12), estimated VO2max (P=.34), balance (P=.24), knee range of motion (left: P=.35; right: P=.31), or hamstring flexibility (P=.14). There was a significant decrease in diastolic blood pressure (P=.04) and significant increases in shoulder flexibility (P<.001) and leg press 1-repetition maximum volume (P=.04). Participants reported improvements in overall health, endurance, flexibility, and mood as well as improvements to team environment and health behaviors around the station; however, there was a decline in overcoming barriers to physical activity. Conclusions: A 14-week program of exercise training in firefighters elicited improvements in clinical, performance, and self-reported physical activity outcomes. This occupational exercise training program for firefighters increased time spent exercising, improved team building, and led to physical and mental health benefits. Results from this pilot study set a broad, informed, and meaningful foundation for future efforts to increase firefighter participation in occupational fitness programs. ",
doi="10.2196/17835",
url="http://formative.jmir.org/2020/9/e17835/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955453"
}


@Article{info:doi/10.2196/11543,
author="Brunet, Jennifer
and Tulloch, E. Heather
and Wolfe Phillips, Emily
and Reid, D. Robert
and Pipe, L. Andrew
and Reed, L. Jennifer",
title="Motivation Predicts Change in Nurses' Physical Activity Levels During a Web-Based Worksite Intervention: Results From a Randomized Trial",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="11",
volume="22",
number="9",
pages="e11543",
keywords="physical activity",
keywords="motivation",
keywords="wearable technology",
keywords="nurses",
abstract="Background: Low physical activity levels can negatively affect the health of nurses. Given the low physical activity levels reported by nurses, there is a clear need for brief and economical interventions designed to increase physical activity levels in this population. We developed a web-based intervention that used motivational strategies to increase nurses' physical activity levels. The intervention provided the nurses with feedback from an activity monitor coupled with a web-based individual, friend, or team physical activity challenge. Objective: In this parallel-group randomized trial, we examine whether nurses' motivation at baseline predicted changes in objectively measured physical activity levels during the 6-week intervention. Methods: The participants were 76 nurses (n=74, 97\% female; mean age 46, SD 11 years) randomly assigned to 1 of 3 physical activity challenge conditions: (1) individual, (2) friend, or (3) team. The nurses completed a web-based questionnaire designed to assess motivational regulations for physical activity levels before the intervention and wore a Tractivity activity monitor before and during the 6-week intervention. We analyzed data using multilevel modeling for repeated measures. Results: The nurses' physical activity levels increased (linear estimate=10.30, SE 3.15; P=.001), but the rate of change decreased over time (quadratic estimate=?2.06, SE 0.52; P<.001). External and identified regulations ({\ss}=?2.08 to 11.55; P=.02 to .04), but not intrinsic and introjected regulations ({\ss}=?.91 to 6.29; P=.06 to .36), predicted changes in the nurses' physical activity levels. Conclusions: Our findings provide evidence that an intervention that incorporates self-monitoring and physical activity challenges can be generally effective in increasing nurses' physical activity levels in the short term. They also suggest that drawing solely on organismic integration theory to predict changes in physical activity levels among the nurses participating in web-based worksite interventions may have been insufficient. Future research should examine additional personal (eg, self-efficacy) and occupational factors (eg, shift length and shift type) that influence physical activity levels to identify potential targets for intervention among nurses. Trial Registration: ClinicalTrials.gov NCT04524572; https://clinicaltrials.gov/ct2/show/NCT04524572 ",
doi="10.2196/11543",
url="http://www.jmir.org/2020/9/e11543/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32915158"
}


@Article{info:doi/10.2196/18051,
author="Hill, J. Brandon
and Motley, N. Darnell
and Rosentel, Kris
and VandeVusse, Alicia
and Garofalo, Robert
and Kuhns, M. Lisa
and Kipke, D. Michele
and Reisner, Sari
and Rupp, Betty
and West Goolsby, Rachel
and McCumber, Micah
and Renshaw, Laura
and Schneider, A. John",
title="Work2Prevent, an Employment Intervention Program as HIV Prevention for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 3): Protocol for a Single-Arm Community-Based Trial to Assess Feasibility and Acceptability in a Real-World Setting",
journal="JMIR Res Protoc",
year="2020",
month="Sep",
day="11",
volume="9",
number="9",
pages="e18051",
keywords="HIV/AIDS",
keywords="youth",
keywords="young men who have sex with men",
keywords="YMSM",
keywords="young transgender women",
keywords="YTW",
keywords="gender nonconforming youth",
keywords="LGBTQ",
keywords="unemployment",
keywords="homelessness",
keywords="sex work",
abstract="Background: In the United States, young cisgender men who have sex with men (YMSM), young transgender women (YTW), and gender nonconforming (GNC) youth face elevated rates of HIV infection. However, racial and ethnic disparities in adolescent HIV infection cannot be attributed to individual-level factors alone and are situated within larger social and structural contexts that marginalize and predispose sexual and gender minority youth of color to HIV. Addressing broader ecological factors that drive transmission requires interventions that focus on the distal drivers of HIV infection, including violence exposure, housing, food insecurity, educational attainment, and employment. Given the ways that economic instability may make YMSM, YTW, and GNC youth of color vulnerable to HIV exposure, this study focuses on employment as an HIV prevention intervention. More specifically, the intervention, called Work2Prevent (W2P), targets economic stability through job readiness and employment as a means of preventing behaviors and factors associated with adolescent and young adult HIV, such as transactional sex work and homelessness. The intervention was adapted from iFOUR, an evidence-based employment program for HIV-positive adults in phase 1 of this study, and pilot tested in a university-based setting in phase 2. Objective: This paper aims to describe the protocol for the community-based test phase of W2P. The purpose of this phase was to pilot test a tailored, theoretically informed employment intervention program among YMSM, YTW, and GNC youth of color within a lesbian, gay, bisexual, transgender, and queer (LGBTQ) community setting. Methods: The employment intervention was pilot tested using a single-arm pretest-posttest trial design implemented among a sample of vulnerable YMSM, YTW, and GNC youth of color using services within a community-based LGBTQ center. Assessments will examine intervention feasibility, acceptability, and preliminary estimates of efficacy. Results: Phase 3 of W2P research activities began in May 2019 and was completed in December 2019. Overall, 41 participants were enrolled in the community-based pilot. Conclusions: This study will assess intervention feasibility and acceptability in the target populations and determine preliminary efficacy of the intervention to increase employment and reduce vulnerability to HIV when implemented in a community-based setting serving LGBTQ youth of color. Testing the intervention in a community setting is an opportunity to evaluate how recruitment, retention, and other outcomes are impacted by delivery in a venue akin to where this intervention could eventually be used by nonresearchers. If W2P demonstrates feasibility and acceptability, a larger multisite trial implemented in multiple community settings serving YMSM, YTW, and GNC youth of color is planned. Trial Registration: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310 International Registered Report Identifier (IRRID): DERR1-10.2196/18051 ",
doi="10.2196/18051",
url="https://www.researchprotocols.org/2020/9/e18051",
url="http://www.ncbi.nlm.nih.gov/pubmed/32915162"
}


@Article{info:doi/10.2196/18253,
author="van Kraaij, Jacobus Alex Wilhelmus
and Schiavone, Giuseppina
and Lutin, Erika
and Claes, Stephan
and Van Hoof, Chris",
title="Relationship Between Chronic Stress and Heart Rate Over Time Modulated by Gender in a Cohort of Office Workers: Cross-Sectional Study Using Wearable Technologies",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="9",
volume="22",
number="9",
pages="e18253",
keywords="chronic stress",
keywords="heart rate",
keywords="circadian rhythm",
keywords="gender",
keywords="age",
keywords="wearable device",
abstract="Background: Chronic stress is increasing in prevalence and is associated with several physical and mental disorders. Although it is proven that acute stress changes physiology, much less is known about the relationship between physiology and long-term stress. Continuous measurement of vital signs in daily life and chronic stress detection algorithms could serve this purpose. For this, it is paramount to model the effects of chronic stress on human physiology and include other cofounders, such as demographics, enabling the enrichment of a population-wide approach with individual variations. Objective: The main objectives of this study were to investigate the effect of chronic stress on heart rate (HR) over time while correcting for weekdays versus weekends and to test a possible modulation effect by gender and age in a healthy cohort. Methods: Throughout 2016 and 2017, healthy employees of technology companies were asked to participate in a 5-day observation stress study. They were required to wear two wearables, of which one included an electrocardiogram sensor. The derived HR was averaged per hour and served as an output for a mixed design model including a trigonometric fit over time with four harmonics (periods of 24, 12, 8, and 6 hours), gender, age, whether it was a workday or weekend day, and a chronic stress score derived from the Perceived Stress Scale (PSS) as predictors. Results: The study included 328 subjects, of which 142 were female and 186 were male participants, with a mean age of 38.9 (SD 10.2) years and a mean PSS score of 13.7 (SD 6.0). As main effects, gender ($\chi$21=24.02, P<.001); the hour of the day ($\chi$21=73.22, P<.001); the circadian harmonic ($\chi$22=284.4, P<.001); and the harmonic over 12 hours ($\chi$22=242.1, P<.001), over 8 hours ($\chi$22=23.78, P<.001), and over 6 hours ($\chi$22=82.96, P<.001) had a significant effect on HR. Two three-way interaction effects were found. The interaction of age, whether it was a workday or weekend day, and the circadian harmonic over time were significantly correlated with HR ($\chi$22=7.13, P=.03), as well as the interaction of gender, PSS score, and the circadian harmonic over time ($\chi$22=7.59, P=.02). Conclusions: The results show a relationship between HR and the three-way interaction of chronic stress, gender, and the circadian harmonic. The modulation by gender might be related to evolution-based energy utilization strategies, as suggested in related literature studies. More research, including daily cortisol assessment, longer recordings, and a wider population, should be performed to confirm this interpretation. This would enable the development of more complete and personalized models of chronic stress. ",
doi="10.2196/18253",
url="http://www.jmir.org/2020/9/e18253/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32902392"
}


@Article{info:doi/10.2196/19500,
author="Jukic, Tomislav
and Ihan, Alojz
and Petek {\vS}ter, Marija
and Strojnik, Vojko
and Stubljar, David
and Starc, Andrej",
title="Adherence of Female Health Care Workers to the Use a Web-Based Tool for Improving and Modifying Lifestyle: Prospective Target Group Pilot Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="14",
volume="22",
number="8",
pages="e19500",
keywords="mHealth",
keywords="eHealth",
keywords="health care workers",
keywords="occupational stress",
keywords="burnout",
keywords="adherence",
keywords="web-based tool",
abstract="Background: Health care professionals are exposed to the psychological and physiological effects of stress, which is a well-known risk factor for various mental and physical health problems. Objective: The aims of this study were to assess the adherence of female health care workers to use a web-based tool for improving and modifying lifestyle and to identify the potential factors influencing their adherence. Methods: A prospective, observational study was performed. A total of 80 female health care workers (physicians and gradated nurses) from 2 university medical centers and female members of a family medicine society participated. Participants completed a questionnaire that inquired about their basic demographic data and physical fitness. Physical fitness was assessed by the Rockport Fitness Walking Test. Adherence to a web-based application (24@life) was followed for 3 months and the number of log-ins into the application was counted. Results: The study was conducted from March to October 2019. Significantly high workload has been detected in all groups (P<.05), except in the general practitioner with normal workload group. The graduated nurse working in the surgery room group showed chronic stress with elevated S-cortisol levels (>690 nmol/L); activated cellular immune system with elevated concentrations of lymphocytes (reference 1.1-2.5 {\texttimes} 109 cells/L), CD3 cells (reference 0.7-1.9 {\texttimes} 109 cells/L), CD8 cells (reference 0.2-0.7 {\texttimes} 109 cells/L), and HLA-DR/CD3 cells (reference 0.04-0.2 {\texttimes} 109 cells/L); and the worst quality of sleep (mean 2.8 [SD 1.2]). Only 32 of 80 participants (40\%) were adherent to the web-based application. Participants most frequently viewed web pages on areas of physical activity (497 times) and nutrition (332 times). No factors or participant's characteristics such as weight (odds ratio [OR] 1.026, 95\% CI 0.977-1.078), BMI (OR 0.993, 95\% CI 0.834-1.184), age (OR 0.970, 95\% CI 0.910-1.034), or stress level (OR 0.997, 95\% CI 0.995-1.000) were identified to affect the adherence rates. Conclusions: Female health care workers exposed to high workload did not find the web-based application useful for improving and modifying their lifestyle. Therefore, other strategies that might help health care workers facing stress and improve their lifestyle should be identified. ",
doi="10.2196/19500",
url="https://www.jmir.org/2020/8/e19500",
url="http://www.ncbi.nlm.nih.gov/pubmed/32687475"
}


@Article{info:doi/10.2196/19222,
author="Min, Kyoung-Bok
and Song, Sung-Hee
and Min, Jin-Young",
title="Topic Modeling of Social Networking Service Data on Occupational Accidents in Korea: Latent Dirichlet Allocation Analysis",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="13",
volume="22",
number="8",
pages="e19222",
keywords="topic modeling",
keywords="occupational accident",
keywords="social media",
keywords="knowledge",
keywords="workplace",
keywords="accident",
keywords="model",
keywords="analysis",
keywords="safety",
abstract="Background: In most industrialized societies, regulations, inspections, insurance, and legal options are established to support workers who suffer injury, disease, or death in relation to their work; in practice, these resources are imperfect or even unavailable due to workplace or employer obstruction. Thus, limitations exist to identify unmet needs in occupational safety and health information. Objective: The aim of this study was to explore hidden issues related to occupational accidents by examining social network services (SNS) data using topic modeling. Methods: Based on the results of a Google search for the phrases occupational accident, industrial accident and occupational diseases, a total of 145 websites were selected. From among these websites, we collected 15,244 documents on queries related to occupational accidents between 2002 and 2018. To transform unstructured text into structure data, natural language processing of the Korean language was conducted. We performed the latent Dirichlet allocation (LDA) as a topic model using a Python library. A time-series linear regression analysis was also conducted to identify yearly trends for the given documents. Results: The results of the LDA model showed 14 topics with 3 themes: workers' compensation benefits (Theme 1), illicit agreements with the employer (Theme 2), and fatal and non-fatal injuries and vulnerable workers (Theme 3). Theme 1 represented the largest cluster (52.2\%) of the collected documents and included keywords related to workers' compensation (ie, company, occupational injury, insurance, accident, approval, and compensation) and keywords describing specific compensation benefits such as medical expense benefits, temporary incapacity benefits, and disability benefits. In the yearly trend, Theme 1 gradually decreased; however, other themes showed an overall increasing pattern. Certain queries (ie, musculoskeletal system, critical care, and foreign workers) showed no significant variation in the number of queries. Conclusions: We conducted LDA analysis of SNS data of occupational accident--related queries and discovered that the primary concerns of workers posting about occupational injuries and diseases were workers' compensation benefits, fatal and non-fatal injuries, vulnerable workers, and illicit agreements with employers. While traditional systems focus mainly on quantitative monitoring of occupational accidents, qualitative aspects formulated by topic modeling from unstructured SNS queries may be valuable to address inequalities and improve occupational health and safety. ",
doi="10.2196/19222",
url="http://www.jmir.org/2020/8/e19222/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32663156"
}


@Article{info:doi/10.2196/17145,
author="Elling, Lysandra Devy
and Wilson, Martina
and Carlbring, Per
and Wennberg, Peter
and Sundqvist, Kristina",
title="Effectiveness of Combining Organizational Alcohol Policy and Skills Training for Managers to Reduce Hazardous Alcohol Consumption in Swedish Workplaces: Study Protocol for a Cluster Randomized Study",
journal="JMIR Res Protoc",
year="2020",
month="Aug",
day="12",
volume="9",
number="8",
pages="e17145",
keywords="alcohol prevention",
keywords="health promotion",
keywords="workplace intervention",
keywords="hazardous alcohol use",
keywords="alcohol use",
keywords="intervention",
keywords="workplace",
abstract="Background: High alcohol consumption poses risks to individual health and society. Previous alcohol interventions have mainly focused on high-risk consumers or young adults in school-based settings. Since the majority of the adult population is in the workforce, the workplace can be considered a favorable arena for implementing interventions. Objective: This protocol describes a project aimed at increasing knowledge of the effectiveness of combining the implementation of an organizational alcohol policy with skills training for managers as a workplace alcohol prevention program, by evaluating the intervention and exploring managers' perceptions of the intervention. Methods: Organizations with at least 100 employees were invited to take part in the project. A total of 11 organizations (744 managers and 11,761 employees) were included in the project. Data are collected through self-administered online surveys at baseline, 12 months, and 24 months. The primary outcome is managers' inclination to initiate an early alcohol intervention (eg, by initiating a dialogue) when concern regarding employees' hazardous alcohol consumption arises. The secondary outcomes of interest are managers' and employees' organizational alcohol policy knowledge and changes in alcohol consumption, as measured using the Alcohol Use Disorder Identification Test (AUDIT) score. A linear mixed-model framework will be used to model variability on different levels. Primary analysis will follow an intention-to-treat approach. Additionally, managers' responses from semistructured interviews will be analyzed using thematic analysis to explore managers' experiences regarding the prevention program. Results: This study is ongoing. The overall study start was on January 2018, and the study is planned to end in December 2020. Baseline and 12-month follow-up measurements have been collected. Conclusions: This project is designed to evaluate the effectiveness of an alcohol prevention program regarding higher inclination to initiate early alcohol interventions after policy implementation and skills training among managers, compared to the usual practices in the workplace. The results from this study can contribute to increased knowledge about alcohol interventions and future prevention programs in the workplace. Trial Registration: ISRCTN17250048; http://www.isrctn.com/ISRCTN17250048 International Registered Report Identifier (IRRID): DERR1-10.2196/17145 ",
doi="10.2196/17145",
url="https://www.researchprotocols.org/2020/8/e17145",
url="http://www.ncbi.nlm.nih.gov/pubmed/32784185"
}


@Article{info:doi/10.2196/16422,
author="Bao, Hongchang
and Baker, O. Christopher J.
and Adisesh, Anil",
title="Occupation Coding of Job Titles: Iterative Development of an Automated Coding Algorithm for the Canadian National Occupation Classification (ACA-NOC)",
journal="JMIR Form Res",
year="2020",
month="Aug",
day="5",
volume="4",
number="8",
pages="e16422",
keywords="occupation coding",
keywords="automated coding",
keywords="occupational health",
keywords="job title",
abstract="Background: In many research studies, the identification of social determinants is an important activity, in particular, information about occupations is frequently added to existing patient data. Such information is usually solicited during interviews with open-ended questions such as ``What is your job?'' and ``What industry sector do you work in?'' Before being able to use this information for further analysis, the responses need to be categorized using a coding system, such as the Canadian National Occupational Classification (NOC). Manual coding is the usual method, which is a time-consuming and error-prone activity, suitable for automation. Objective: This study aims to facilitate automated coding by introducing a rigorous algorithm that will be able to identify the NOC (2016) codes using only job title and industry information as input. Using manually coded data sets, we sought to benchmark and iteratively improve the performance of the algorithm. Methods: We developed the ACA-NOC algorithm based on the NOC (2016), which allowed users to match NOC codes with job and industry titles. We employed several different search strategies in the ACA-NOC algorithm to find the best match, including exact search, minor exact search, like search, near (same order) search, near (different order) search, any search, and weak match search. In addition, a filtering step based on the hierarchical structure of the NOC data was applied to the algorithm to select the best matching codes. Results: The ACA-NOC was applied to over 500 manually coded job and industry titles. The accuracy rate at the four-digit NOC code level was 58.7\% (332/566) and improved when broader job categories were considered (65.0\% at the three-digit NOC code level, 72.3\% at the two-digit NOC code level, and 81.6\% at the one-digit NOC code level). Conclusions: The ACA-NOC is a rigorous algorithm for automatically coding the Canadian NOC system and has been evaluated using real-world data. It allows researchers to code moderate-sized data sets with occupation in a timely and cost-efficient manner such that further analytics are possible. Initial assessments indicate that it has state-of-the-art performance and is readily extensible upon further benchmarking on larger data sets. ",
doi="10.2196/16422",
url="https://formative.jmir.org/2020/8/e16422",
url="http://www.ncbi.nlm.nih.gov/pubmed/32755893"
}


@Article{info:doi/10.2196/15338,
author="Bort-Roig, Judit
and Chirveches-P{\'e}rez, Emilia
and Garcia-Cuy{\`a}s, Francesc
and Dowd, P. Kieran
and Puig-Ribera, Anna",
title="Monitoring Occupational Sitting, Standing, and Stepping in Office Employees With the W@W-App and the MetaWearC Sensor: Validation Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="4",
volume="8",
number="8",
pages="e15338",
keywords="validity",
keywords="self-monitoring",
keywords="sedentary behavior",
keywords="physical activity",
keywords="smartphone",
keywords="mobile phone",
keywords="device-based measure",
abstract="Background: Replacing occupational sitting time with active tasks has several proposed health benefits for office employees. Mobile phones and motion sensors can provide objective information in real time on occupational sitting behavior. However, the validity and feasibility of using mobile health (mHealth) devices to quantify and modify occupational sedentary time is unclear. Objective: The aim of this study is to validate the new Walk@Work-Application (W@W-App)---including an external motion sensor (MetaWearC) attached to the thigh---for measuring occupational sitting, standing, and stepping in free-living conditions against the activPAL3M, the current gold-standard, device-based measure for postural behaviors. Methods: In total, 20 office workers (16 [80\%] females; mean age 39.5, SD 8.1 years) downloaded the W@W-App to their mobile phones, wore a MetaWearC sensor attached to their thigh using a tailored band, and wore the activPAL3M for 3-8 consecutive working hours. Differences between both measures were examined using paired-samples t tests and Wilcoxon signed-rank tests. Agreement between measures was examined using concordance correlation coefficients (CCCs), 95\% CIs, Bland-Altman plots (mean bias, 95\% limits of agreement [LoA]), and equivalence testing techniques. Results: The median recording time for the W@W-App+MetaWearC and the activPAL3M was 237.5 (SD 132.8) minutes and 240.0 (SD 127.5) minutes, respectively (P<.001). No significant differences between sitting (P=.53), standing (P=.12), and stepping times (P=.61) were identified. The CCC identified substantial agreement between both measures for sitting (CCC=0.98, 95\% CI 0.96-0.99), moderate agreement for standing (CCC=0.93, 95\% CI 0.81-0.97), and poor agreement for stepping (CCC=0.74, 95\% CI 0.47-0.88). Bland-Altman plots indicated that sitting time (mean bias --1.66 minutes, 95\% LoA --30.37 to 20.05) and standing time (mean bias --4.85 minutes, 95\% LoA --31.31 to 21.62) were underreported. For stepping time, a positive mean bias of 1.15 minutes (95\% LoA --15.11 to 17.41) was identified. Equivalence testing demonstrated that the estimates obtained from the W@W-App+MetaWearC and the activPAL3M were considered equivalent for all variables excluding stepping time. Conclusions: The W@W-App+MetaWearC is a low-cost tool with acceptable levels of accuracy that can objectively quantify occupational sitting, standing, stationary, and upright times in real time. Due to the availability of real-time feedback for users, this tool can positively influence occupational sitting behaviors in future interventions. Trial Registration: ClinicalTrials.gov NCT04092738; https://clinicaltrials.gov/ct2/show/NCT04092738 ",
doi="10.2196/15338",
url="https://mhealth.jmir.org/2020/8/e15338",
url="http://www.ncbi.nlm.nih.gov/pubmed/32459625"
}


@Article{info:doi/10.2196/17857,
author="Yan, Yu-Hua
and Chien, Tsair-Wei
and Yeh, Yu-Tsen
and Chou, Willy
and Hsing, Shu-Chen",
title="An App for Classifying Personal Mental Illness at Workplace Using Fit Statistics and Convolutional Neural Networks: Survey-Based Quantitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="31",
volume="8",
number="7",
pages="e17857",
keywords="respiratory therapist",
keywords="ELMI app",
keywords="Rasch analysis",
keywords="convolutional neural network",
keywords="mental health",
keywords="mobile phone",
abstract="Background: Mental illness (MI) is common among those who work in health care settings. Whether MI is related to employees' mental status at work is yet to be determined. An MI app is developed and proposed to help employees assess their mental status in the hope of detecting MI at an earlier stage. Objective: This study aims to build a model using convolutional neural networks (CNNs) and fit statistics based on 2 aspects of measures and outfit mean square errors for the automatic detection and classification of personal MI at the workplace using the emotional labor and mental health (ELMH) questionnaire, so as to equip the staff in assessing and understanding their own mental status with an app on their mobile device. Methods: We recruited 352 respiratory therapists (RTs) working in Taiwan medical centers and regional hospitals to fill out the 44-item ELMH questionnaire in March 2019. The exploratory factor analysis (EFA), Rasch analysis, and CNN were used as unsupervised and supervised learnings for (1) dividing RTs into 4 classes (ie, MI, false MI, health, and false health) and (2) building an ELMH predictive model to estimate 108 parameters of the CNN model. We calculated the prediction accuracy rate and created an app for classifying MI for RTs at the workplace as a web-based assessment. Results: We observed that (1) 8 domains in ELMH were retained by EFA, (2) 4 types of mental health (n=6, 63, 265, and 18 located in 4 quadrants) were classified using the Rasch analysis, (3) the 44-item model yields a higher accuracy rate (0.92), and (4) an MI app available for RTs predicting MI was successfully developed and demonstrated in this study. Conclusions: The 44-item model with 108 parameters was estimated by using CNN to improve the accuracy of mental health for RTs. An MI app developed to help RTs self-detect work-related MI at an early stage should be made more available and viable in the future. ",
doi="10.2196/17857",
url="https://mhealth.jmir.org/2020/7/e17857",
url="http://www.ncbi.nlm.nih.gov/pubmed/32735232"
}


@Article{info:doi/10.2196/17914,
author="Huang, Yitong
and Benford, Steve
and Price, Dominic
and Patel, Roma
and Li, Benqian
and Ivanov, Alex
and Blake, Holly",
title="Using Internet of Things to Reduce Office Workers' Sedentary Behavior: Intervention Development Applying the Behavior Change Wheel and Human-Centered Design Approach",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="29",
volume="8",
number="7",
pages="e17914",
keywords="sedentary behavior",
keywords="workplace",
keywords="just-in-time adaptive intervention",
keywords="internet of things",
abstract="Background: Sedentary behavior (SB) is associated with various adverse health outcomes. The prevalence of prolonged sitting at work among office workers makes a case for SB interventions to target this setting and population. Everyday mundane objects with embedded microelectronics and ubiquitous computing represent a novel mode of delivering health behavior change interventions enabled by internet of things (IoTs). However, little is known about how to develop interventions involving IoT technologies. Objective: This paper reports the design and development of an IoT-enabled SB intervention targeting office workers. Methods: The process was guided by the behavior change wheel (BCW), a systematic framework for theory-informed and evidence-based development of behavior change interventions, complemented by the human-centered design (HCD) approach. Intervention design was shaped by findings from a diary-probed interview study (n=20), a stakeholder design workshop (n=8), and a series of theoretical mapping and collaborative technical design activities. Results: The resulting intervention named WorkMyWay targets a reduction in office workers' prolonged stationary behaviors at work and an increase in regular breaks by modifying behavioral determinants in 11 theoretical domains with 17 behavior change techniques. The delivery technology consists of a wearable activity tracker, a light-emitting diode reminder device attached to a vessel (ie, water bottle or cup), and a companion Android app connected to both devices over Bluetooth. The delivery plan consists of a 2-week baseline assessment, a 30-min face-to-face action planning session, and 6-week self-directed use of the delivery technology. Conclusions: This is the first study to demonstrate that it is possible to develop a complex IoT-enabled intervention by applying a combination of the BCW and HCD approaches. The next step is to assess the feasibility of WorkMyWay prior to testing intervention efficacy in a full-scale trial. The intervention mapping table that links individual intervention components with hypothesized mechanisms of action can serve as the basis for testing and clarifying theory-based mechanisms of action in future studies on WorkMyWay. ",
doi="10.2196/17914",
url="http://mhealth.jmir.org/2020/7/e17914/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32723716"
}


@Article{info:doi/10.2196/14951,
author="Berninger, M. Nathalie
and ten Hoor, A. Gill
and Plasqui, Guy
and Kok, Gerjo
and Peters, Ygram Gjalt-Jorn
and Ruiter, C. Robert A.",
title="Sedentary Work in Desk-Dominated Environments: A Data-Driven Intervention Using Intervention Mapping",
journal="JMIR Form Res",
year="2020",
month="Jul",
day="20",
volume="4",
number="7",
pages="e14951",
keywords="intervention mapping",
keywords="sedentary behavior",
keywords="sedentary work",
keywords="computer-based",
keywords="occupational health",
keywords="eHealth",
keywords="mHealth",
keywords="data-driven programs",
abstract="Background: Since desk-dominated work environments facilitate sedentary behavior, office workers sit for 66\% of their working days and only 8\% succeed in interrupting their prolonged periods of sitting within the first 55 minutes. Yet stretches of long and uninterrupted sitting increase the likelihood of several chronic metabolic and cardiovascular diseases. Objective: We therefore developed a computer-based app designed to interrupt periods of prolonged sitting among office employees. Methods: When developing the intervention, we applied the intervention mapping protocol. This approach for the systematic design of theory and evidence-based behavior change programs consists of 6 steps: creation of a logic model of the problem, creation of a logic model of change, program design, program production, design of an implementation plan, and development of an evaluation plan. Results: Working through all 6 steps has resulted in an individually adaptable intervention to reduce sedentary behavior at work. The intervention, UPcomplish, consists of tailored, half-automatized motivational components delivered by a coach. To register sedentary behavior, the VitaBit (VitaBit Software International BV) toolkit, a wearable accelerometry-based monitoring device, is used. Among others, UPcomplish includes personalized goal setting, tailored suggestions to overcome hurdles, and weekly challenges. The VitaBit toolkit supports the participants to monitor their behavior in relation to self-set goals. Conclusions: Intervention mapping is a useful protocol not only for the systematic development of a comprehensive intervention to reduce sedentary behavior but also for planning program adherence, program implementation, and program maintenance. It facilitates obtaining the participation of relevant stakeholders at different ecological levels in the development process of the intervention and anticipating facilitators to and barriers of program implementation and maintenance. Trial Registration: Netherlands Trial Register NL7503; https://www.trialregister.nl/trial/7503 ",
doi="10.2196/14951",
url="http://formative.jmir.org/2020/7/e14951/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706695"
}


@Article{info:doi/10.2196/18693,
author="Forsstr{\"o}m, David
and Sundstr{\"o}m, Christopher
and Berman, H. Anne
and Sundqvist, Kristina",
title="Internet-Delivered Cognitive Behavioral Therapy for Problematic Alcohol Use in a Workplace Setting: Protocol for Quantitative and Qualitative Evaluation of Feasibility and Outcomes",
journal="JMIR Res Protoc",
year="2020",
month="Jul",
day="15",
volume="9",
number="7",
pages="e18693",
keywords="workplace setting",
keywords="ICBT",
keywords="alcohol",
keywords="protocol",
keywords="mental health",
keywords="feasibility",
keywords="CBT",
keywords="cognitive behavioral therapy",
keywords="intervention",
keywords="workplace",
abstract="Background: Internet-based cognitive behavioral therapy (ICBT) for mental health issues has been successfully implemented in routine health care settings, and research indicates that ICBT can also be applied to decrease problematic alcohol use in workplace settings. However, studies investigating the feasibility of implementing ICBT in a workplace setting have been lacking. Objective: The current study aims to investigate the feasibility of delivering ICBT for problematic alcohol use within an employee assistance program (EAP). Methods: The study has a quantitative naturalistic design, quantitively comparing ICBT and face-to-face treatment, and allowing for qualitative interviews with employees and employers. Recruitment of participants follows a five-session in-person psychological assessment at an EAP regarding an employee's presumed problematic alcohol consumption. All assessed employees referred to ICBT or face-to-face treatment will be offered participation in the study. Interviews will be held with employees and their employer representatives following ICBT to elucidate both stakeholders' experience and perception of ICBT and its context. Outcome comparisons between ICBT and face-to-face treatment will be assessed quantitatively using a Reliable Change Index and analysis of variance. Thematic analysis and Grounded Theory will be used to analyze the interview material. Results: The study is set to begin in April 2020 and to end in September 2021. The aim is to recruit up to 150 participants to the quantitative part of the study and 45 participants (15 employees and 30 employer representatives) to the qualitative part of the study. Conclusions: The current study will provide knowledge that is lacking and urgently needed on how to implement ICBT for problematic alcohol use in a workplace setting. International Registered Report Identifier (IRRID): PRR1-10.2196/18693 ",
doi="10.2196/18693",
url="https://www.researchprotocols.org/2020/7/e18693",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673266"
}


@Article{info:doi/10.2196/17368,
author="Niks, MW Irene
and van Drongelen, Alwin
and de Korte, M. Elsbeth",
title="Promoting Employees' Recovery During Shift Work: Protocol for a Workplace Intervention Study",
journal="JMIR Res Protoc",
year="2020",
month="Jul",
day="14",
volume="9",
number="7",
pages="e17368",
keywords="shift work",
keywords="recovery during work",
keywords="fatigue",
keywords="intervention study",
keywords="participatory action research",
keywords="ecological momentary assessment",
keywords="mobile phone",
abstract="Background: Shift work can be demanding owing to disturbances in the biological and social rhythms. This can cause short-term negative effects in employees, such as increased fatigue and reduced alertness. A potential way to counteract these negative effects is to enhance employees' recovery from work during working hours. Objective: The aim of this study is to develop and implement an intervention that focuses on promoting ``on-job'' recovery of shift workers. Methods: This study is performed in 2 department units with shift workers at a multinational company in the steel industry. For each department, an intervention will be developed and implemented through an iterative process of user-centered design and evaluation. This approach consists of various sessions in which employees and a project group (ie, researchers, line managers, human resource managers, and occupational health experts) provide input on the intervention content and implementation. Intervention effects will be evaluated using pretest and posttest web-based surveys. Digital ecological momentary assessment will be performed to gain insight into the link between the intervention and daily within-person processes. The intervention process and participants' perception of the interventions will be assessed through a process evaluation. Intervention results will be analyzed by performing mixed model repeated measures analyses and multilevel analyses. Results: This study is supported by the Netherlands Organization for Applied Scientific Research Work and Health Research Program, which is funded by the Ministry of Economic Affairs and supported by the Dutch Ministry of Social Affairs and Employment, program number 19.204.1-3. This study was approved by the institutional review board on February 7, 2019. From June to August 2019, baseline data were collected, and from November to December 2019, the first follow-up data were collected. The second follow-up data collection and data analysis are planned for the first two quarters of 2020. Dissemination of the results is planned for the last two quarters of 2020. Conclusions: A strength of this study design is the participatory action approach to enhance the stakeholder commitments, intervention adherence, and compliance. Moreover, since the target group will be participating in the development and implementation of the intervention, the proposed impact will be high. In addition, the short-term as well as the long-term effects will be evaluated. Finally, this study uses a unique combination of quantitative and qualitative evaluation methods. A limitation of this study is that it is impossible to randomly assign participants to an intervention or control group. Furthermore, the follow-up period (6 months) might be too short to establish health-related effects. Lastly, the results of this study might be specific to the department, organization, or sector, which limits the generalizability of the findings. However, as workplace intervention research for shift workers is scarce, this study might serve as a starting point for future research on shift work interventions. ",
doi="10.2196/17368",
url="https://www.researchprotocols.org/2020/7/e17368",
url="http://www.ncbi.nlm.nih.gov/pubmed/32459635"
}


@Article{info:doi/10.2196/18181,
author="Lin, Ro-Ting
and Cheng, Yawen
and Jiang, Yan-Cheng",
title="Exploring Public Awareness of Overwork Prevention With Big Data From Google Trends: Retrospective Analysis",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="26",
volume="22",
number="6",
pages="e18181",
keywords="overwork",
keywords="working hours",
keywords="policy",
keywords="big data",
abstract="Background: To improve working conditions and prevent illness and deaths related to overwork, the Taiwanese government in 2015, 2016, and 2018 amended regulations regarding working time, overtime, shifts, and rest days. Such policy changes may lead to a rising public awareness of overwork-related issues, which may in turn reinforce policy development. Objective: This study aimed to investigate to what extent public awareness of overwork-related issues correlated with policy changes. Methods: Policies, laws, and regulations promulgated or amended in Taiwan between January 2004 and November 2019 were identified. We defined 3 working conditions (overwork, long working hours, and high job stress) related to overwork prevention, generated a keyword for each condition, and extracted the search volumes for each keyword on the Google search engine as proxy indicators of public awareness. We then calculated the monthly percentage change in the search volumes using the Joinpoint Regression Program. Results: Apparent peaks in search volumes were observed immediately after policy changes. Especially, policy changes in 2010 were followed by a remarkable peak in search volumes for both overwork and working hours, with the search volumes for overwork increased by 29\% per month from June 2010 to March 2011. This increase was preceded by the implementation of new overwork recognition guidelines and media reports of several suspected overwork-related events. The search volumes for working hours also steadily increased, by 2\% per month in September 2013 and afterward, reaching a peak in January 2017. The peak was likely due to the amendment to the Labor Standards Act, which called for ``1 fixed and 1 flexible day off per week,'' in 2016. The search volumes for job stress significantly increased (P=.026) but only by 0.4\% per month since March 2013. Conclusions: Over the past 15 years, Taiwanese authorities have revised and implemented several policies to prevent overwork-related health problems. Our study suggests a relationship between the implementation of policies that clearly defined the criteria for overwork and working hours and the rising public awareness of the importance of overwork prevention and shorter working hours. ",
doi="10.2196/18181",
url="https://www.jmir.org/2020/6/e18181",
url="http://www.ncbi.nlm.nih.gov/pubmed/32589160"
}


@Article{info:doi/10.2196/18236,
author="Hannerz, Harald
and Albertsen, Karen
and Nielsen, Lindhardt Martin
and Garde, Helene Anne",
title="Prospective Associations Between Working Time Arrangements and Psychiatric Treatment in Denmark: Protocol for a Cohort Study",
journal="JMIR Res Protoc",
year="2020",
month="Jun",
day="15",
volume="9",
number="6",
pages="e18236",
keywords="occupational health",
keywords="long working hours",
keywords="night shift work",
keywords="mood disorders",
keywords="anxiety",
keywords="stress-related disorders",
keywords="psychiatric hospital treatment",
keywords="prescription drugs",
keywords="psychotropic medicine",
abstract="Background: The burden of mental ill health in working-age populations has prompted research on possible links between work-related factors and mental ill health. Long working hours and night shift work are some of the factors that have been studied in relation to the risk of developing mental ill health. Yet, previous studies have not generated conclusive evidence, and further studies of high quality are needed. Objective: This study aims to investigate the prospective association between working time arrangements and mental health in terms of psychotropic drug usage or psychiatric hospital treatment in the general working population of Denmark. Methods: Data on total weekly working hours in any job and night shift work from the Danish Labor Force Survey 2000--2013 will be linked to data from the Psychiatric Central Research Register (expected 2400 cases during 700,000 person years at risk) and National Prescription Registry (expected 17,400 cases during 600,000 person years at risk). Participants will be followed for up to 5 years. We will use Poisson regression to separately analyze incidence rates of redeemed prescriptions for psychotropic medicine and incidence rates of psychiatric hospital treatment due to mood disorders, anxiety disorders, or stress-related  disorders as a function of weekly working hours and night shift work. The analyses will be controlled for sex, age, calendar time of the interview, and socioeconomic status. Results: This is a study protocol. Power calculations indicate that the study has sufficient statistical power to detect relatively small differences in risks and minor interactions (eg, {\textasciitilde}90\% power to detect a rate ratio of 1.1 for psychoactive medication use). We expect the analyses to be completed by the end of 2020 and the results to be published in 2021. Conclusions: In this study protocol, all hypotheses and statistical models of the project have been completely defined before we link the exposure data to the outcome data. The results of the project will indicate to what extent and in what direction the national burden of mental ill health in Denmark has been influenced by long working hours and night shift work. International Registered Report Identifier (IRRID): DERR1-10.2196/18236 ",
doi="10.2196/18236",
url="https://www.researchprotocols.org/2020/6/e18236",
url="http://www.ncbi.nlm.nih.gov/pubmed/32442158"
}


@Article{info:doi/10.2196/14093,
author="Tchir, Richard Devan
and Szafron, Lorne Michael",
title="Occupational Health Needs and Predicted Well-Being in Office Workers Undergoing Web-Based Health Promotion Training: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="May",
day="26",
volume="22",
number="5",
pages="e14093",
keywords="eHealth",
keywords="health promotion",
keywords="occupational health",
keywords="well-being",
keywords="internet",
keywords="workplace",
abstract="Background: Office workers face workplace-related health issues, including stress and back pain, resulting in considerable cost to businesses and health care systems. Workplace health promotion attempts to prevent these health issues, and the internet can be used to deliver workplace health promotion interventions to office workers. Data were provided by Fitbase GmbH, a German company, which specializes in workplace health promotion via the internet (Web-based health). The Web-based health intervention allowed workers to focus on different health categories by using information modules (reading health information) and/or completing practical exercises (guided, interactive health tutorials). Objective: This study aimed to identify the extent to which office workers have workplace-related health issues, assess whether office workers who differ in their health focus also differ in their improved well-being, and assess whether completing practical exercises is associated with improved well-being compared with reading information modules. Methods: Fitbase GmbH collected data for the period of February 2016 to May 2017 from health insurance employees undergoing Web-based health training in Hamburg, Germany. The data consisted of a needs assessment examining health issues faced by office workers, a wellness questionnaire regarding one's perception of the Web-based health intervention, and activity logs of information modules and practical exercises completed. Through logistic regression, we determined associations between improved well-being from Web-based health training and differences in a worker's health focus and a worker's preferred intervention method. Results: Nearly half of the office workers had chronic back pain (1532/3354) and felt tense or irritated (1680/3348). Over four-fifth (645/766) of the office workers indicated that the Web-based health training improved their well-being (P<.001). Office workers who preferred practical exercises compared with information modules had 2.22 times greater odds of reporting improved well-being from the Web-based health intervention (P=.01; 95\% CI 1.20-4.11). Office workers with a focus on practical exercises for back health had higher odds of improved well-being compared with other health foci. Office workers focused on practical exercises for back pain had at least two times the odds of having their well-being improved from the Web-based health intervention compared with those focused on stress management (P<.001), mindfulness (P=.02), stress management/mindfulness (P=.005), and eye health (P=.003). No particular health focus was associated with improved well-being for the information modules. Conclusions: Office workers frequently report having back pain and stress. A focus on Web-based health training via practical exercises and practical exercises for back health predict an improvement in office workers' reported well-being. ",
doi="10.2196/14093",
url="http://www.jmir.org/2020/5/e14093/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32452806"
}


@Article{info:doi/10.2196/15085,
author="Piao, Meihua
and Ryu, Hyeongju
and Lee, Hyeongsuk
and Kim, Jeongeun",
title="Use of the Healthy Lifestyle Coaching Chatbot App to Promote Stair-Climbing Habits Among Office Workers: Exploratory Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="19",
volume="8",
number="5",
pages="e15085",
keywords="exercise",
keywords="habits",
keywords="reward",
keywords="health behavior",
keywords="healthy lifestyle",
abstract="Background: Lack of time for exercise is common among office workers given their busy lives. Because of occupational restrictions and difficulty in taking time off, it is necessary to suggest effective ways for workers to exercise regularly. Sustaining lifestyle habits that increase nonexercise activity in daily life can solve the issue of lack of exercise time. Healthy Lifestyle Coaching Chatbot is a messenger app based on the habit formation model that can be used as a tool to provide a health behavior intervention that emphasizes the importance of sustainability and involvement. Objective: This study aimed to assess the efficacy of the Healthy Lifestyle Coaching Chatbot intervention presented via a messenger app aimed at stair-climbing habit formation for office workers. Methods: From February 1, 2018, to April 30, 2018, a total of 106 people participated in the trial after online recruitment. Participants were randomly assigned to the intervention group (n=57) or the control group (n=49). The intervention group received cues and intrinsic and extrinsic rewards for the entire 12 weeks. However, the control group did not receive intrinsic rewards for the first 4 weeks and only received all rewards as in the intervention group from the fifth to twelfth week. The Self-Report Habit Index (SRHI) of participants was evaluated every week, and the level of physical activity was measured at the beginning and end of the trial. SPSS Statistics version 21 (IBM Corp) was used for statistical analysis. Results: After 4 weeks of intervention without providing the intrinsic rewards in the control group, the change in SRHI scores was 13.54 (SD 14.99) in the intervention group and 6.42 (SD 9.42) in the control group, indicating a significant difference between the groups (P=.04). When all rewards were given to both groups, from the fifth to twelfth week, the change in SRHI scores of the intervention and control groups was comparable at 12.08 (SD 10.87) and 15.88 (SD 13.29), respectively (P=.21). However, the level of physical activity showed a significant difference between the groups after 12 weeks of intervention (P=.045). Conclusions: This study provides evidence that intrinsic rewards are important to enhance the sustainability and effectiveness of an intervention. The Healthy Lifestyle Coaching Chatbot program can be a cost-effective method for healthy habit formation. Trial Registration: Clinical Research Information Service KCT0004009; https://tinyurl.com/w4oo7md ",
doi="10.2196/15085",
url="https://mhealth.jmir.org/2020/5/e15085",
url="http://www.ncbi.nlm.nih.gov/pubmed/32427114"
}


@Article{info:doi/10.2196/15083,
author="Haque, Sanaul Md
and Kangas, Maarit
and J{\"a}ms{\"a}, Timo",
title="A Persuasive mHealth Behavioral Change Intervention for Promoting Physical Activity in the Workplace: Feasibility Randomized Controlled Trial",
journal="JMIR Form Res",
year="2020",
month="May",
day="4",
volume="4",
number="5",
pages="e15083",
keywords="mHealth behavioral change intervention",
keywords="persuasive app",
keywords="UCD",
keywords="game elements",
keywords="physical activity",
keywords="SDT",
abstract="Background: Employees in an office setting are more likely to remain physically inactive. Physical inactivity has become one of the major barriers to overcoming the risk factors for anxiety, depression, coronary heart disease, certain cancers, and type 2 diabetes. Currently, there is a gap in mobile health (mHealth) apps to promote physical activity (PA) for workers in the workplace. Studies on behavior change theories have concluded that health apps generally lack the use of theoretical constructs. Objective: The objective of this study was to study the feasibility of a persuasive app aimed at encouraging PA among employees and to understand the motivational aspects behind the implementation of mHealth apps among office workers. Methods: A 4-week study using a mixed methods (quantitative and qualitative) design was conducted with office-based employees in cities in 4 countries: Oulu, Finland; Carlow, Ireland; London, United Kingdom; and Dhaka, Bangladesh. Of the 220 invited participants (experimental group, n=115; control group, n=105), 84 participated (experimental group, n=56; control group, n=28), consisting of working-age volunteers working in an office setting. Participants used 2 different interventions: The experimental group used an mHealth app for PA motivation, and the control group used a paper diary. The purpose was to motivate employees to engage in healthier behavior regarding the promotion of PA in the workplace. A user-centered design process was followed to design, develop, and evaluate the mHealth app, incorporating self-determination theory (SDT) and using game elements. The paper diary had no specific theory-driven approach, design technique, nor game elements. Results: Compliance with app usage remained relatively low, with 27 participants (experimental group, n=20; control group, n=7) completing the study. The results support the original hypothesis that the mHealth app would help increase PA (ie, promoting daily walking in the workplace) in comparison to a paper diary (P=.033). The mHealth app supported 2 of the basic SDT psychological needs, namely autonomy (P=.004) and competence (P=.014), but not the needs of relatedness (P=.535). Conclusions: The SDT-based mHealth application motivated employees to increase their PA in the workplace. However, compliance with app usage remained low. Future research should further develop the app based on user feedback and test it in a larger sample. ",
doi="10.2196/15083",
url="https://formative.jmir.org/2020/5/e15083",
url="http://www.ncbi.nlm.nih.gov/pubmed/32364506"
}


@Article{info:doi/10.2196/15416,
author="Manning, B. Julia
and Blandford, Ann
and Edbrooke-Childs, Julian
and Marshall, Paul",
title="How Contextual Constraints Shape Midcareer High School Teachers' Stress Management and Use of Digital Support Tools: Qualitative Study",
journal="JMIR Ment Health",
year="2020",
month="Apr",
day="27",
volume="7",
number="4",
pages="e15416",
keywords="school teachers",
keywords="stress",
keywords="health",
keywords="self-management",
keywords="computers",
keywords="technology",
keywords="qualitative research",
keywords="secondary schools",
keywords="wearable devices",
keywords="mobile applications",
keywords="education",
abstract="Background: Persistent psychosocial stress is endemic in the modern workplace, including among midcareer high school (secondary comprehensive) teachers in England. Understanding contextual influences on teachers' self-management of stress along with their use of digital health technologies could provide important insights into creating more usable and accessible stress support interventions. Objective: The aim of this study was to investigate the constraints on stress management and prevention among teachers in the school environment and how this shapes the use of digitally enabled stress management tools. Methods: Semistructured interviews were conducted with 14 teachers from southern England. The interviews were analyzed using thematic analysis. Results: Teachers were unanimous in their recognition of workplace stress, describing physical (such as isolation and scheduling) and cultural (such as stigma and individualism) aspects in the workplace context, which influence their ability to manage stress. A total of 12 participants engaged with technology to self-manage their physical or psychological well-being, with more than half of the participants using consumer wearables, but Web-based or smartphone apps were rarely accessed in school. However, digital well-being interventions recommended by school leaders could potentially be trusted and adopted. Conclusions: The findings from this study bring together both the important cultural and physical contextual constraints on the ability of midcareer high school teachers to manage workplace stress. This study highlights correlates of stress and offers initial insight into how digital health interventions are currently being used to help with stress, both within and outside high schools. The findings add another step toward designing tailored digital stress support for teachers. ",
doi="10.2196/15416",
url="http://mental.jmir.org/2020/4/e15416/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32338623"
}


@Article{info:doi/10.2196/15812,
author="Al-Abhar, Nabil
and Moghram, Saeed Ghuzlan
and Al-Gunaid, Abdulmalek Eshrak
and Al Serouri, Abdulwahed
and Khader, Yousef",
title="Occupational Exposure to Needle Stick Injuries and Hepatitis B Vaccination Coverage Among Clinical Laboratory Staff in Sana'a, Yemen: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Mar",
day="31",
volume="6",
number="1",
pages="e15812",
keywords="injury",
keywords="hepatitis B",
keywords="vaccination",
keywords="biosafety",
keywords="laboratory staff",
keywords="Yemen",
abstract="Background: Laboratory staff handling blood or biological samples are at risk for accidental injury or exposure to blood-borne pathogens. Hepatitis B virus (HBV) vaccinations for laboratory staff can minimize these risks. Objective: The aims of this study were to determine the prevalence of occupational exposure to needle stick injuries (NSIs) and assess HBV vaccination coverage among clinical laboratory staff in Sana'a, Yemen. Methods: A cross-sectional survey was conducted among clinical laboratory staff who were involved in handling and processing laboratory samples at the main public and private clinical laboratories in Sana'a. Data collection was done using a semistructured questionnaire. The questionnaire was divided into 3 parts. Part 1 included information on sociodemographic characteristics of participants. Part 2 included information on the availability of the personal protective equipment in the laboratories, such as lab coats and gloves. Part 3 included questions about the history of injury during work in the laboratory and the vaccination status for HBV. Results: A total of 219/362 (60\%) participants had been accidentally injured while working in the laboratory. Of those, 14.6\% (32/219) had been injured during the last 3 months preceding the data collection. Receiving the biosafety manual was significantly associated with lower risk of injury. Out of those who were injured, 54.8\% (120/219) had received first aid. About three-quarters of respondents reported that they had been vaccinated against HBV. The vaccination against HBV was significantly higher among laboratory staff who were working at private laboratories (P=.01), who had postgraduate degrees (P=.005), and who received the biosafety manual (P=.03). Conclusions: Occupational exposure to NSI is still a major problem among laboratory staff in public and private laboratories in Sana'a, Yemen. The high incidence of injuries among laboratory staff and the low rate of receiving first aid in laboratories combined with low vaccination coverage indicates that all laboratory staff are at risk of exposure to HBV. Therefore, strengthening supervision, legalizing HBV vaccinations for all laboratory staff, and optimizing laboratory practices regarding the management of sharps can minimize risks and prerequisites in Yemen. ",
doi="10.2196/15812",
url="http://publichealth.jmir.org/2020/1/e15812/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32229462"
}


@Article{info:doi/10.2196/12950,
author="Al-Jaberi, Abdulwahid Musheer
and Juni, Hanafiah Muhamad
and Kadir Shahar, Hayati
and Ismail, Fadhilah Siti Irma
and Saeed, Abdu Murad
and Ying, Poh Lim",
title="Effectiveness of an Educational Intervention in Reducing New International Postgraduates' Acculturative Stress in Malaysian Public Universities: Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Feb",
day="27",
volume="9",
number="2",
pages="e12950",
keywords="acculturative stress",
keywords="acculturation",
keywords="international students",
keywords="adjustment",
keywords="protocol",
keywords="cluster",
keywords="randomized controlled trial",
abstract="Background: Universities around the world, including Malaysia, have attracted many international students from different countries. Research has reported that acculturative stress resulting from international students' attempts to adjust to the cultures of host countries is one of the most challenging issues that affects their lives in general and academic lives in particular. Objective: This study aims to examine the effectiveness of an educational intervention on acculturative stress among new postgraduate international students joining Malaysian public universities. Methods: A cluster randomized controlled trial design with Malaysian public universities as the unit of randomization will be used in this study. Public universities will be randomized in a 1:1 ratio to be either in the intervention (educational program) or control group (waiting list). Participants in the intervention group will receive 7 sessions in 9 hours delivered by an expert in psychology and the researcher. The control group will receive the intervention once the 3-month follow-up evaluation is completed. Results: The data will be analyzed using the generalized estimation equation with a confidence interval value of 95\%; significant differences between and within groups are determined as P<.05. The results of the study underlie the effectiveness of educational program in decreasing acculturative stress of new international students and enabling them to cope with a new environment. The results of this study will contribute to previous knowledge of acculturative stress, acculturation, and adjustment of international students. Furthermore, such results are expected to play a role in raising university policy makers' awareness of their postgraduate international students' acculturative stress issues and how they can help them avoid such stress and perform well in their academic life. Conclusions: We expect that the intervention group will score significantly lower than the wait-list group on the immediate and 3-month postintervention evaluation of acculturative stress and achieve a higher level of adjustment. Results will have implications for international students, policy makers at universities, the Malaysian Ministry of Higher Education, and future research. Trial Registration: Clinical Trials Registry India CTRI/2018/01/011223; http://ctri.nic.in/Clinicaltrials/showallp.php?mid1= 21978\&amp;EncHid=\&amp;userName=Muhamad\%20Hanafiah\%20Juni International Registered Report Identifier (IRRID): PRR1-10.2196/12950 ",
doi="10.2196/12950",
url="http://www.researchprotocols.org/2020/2/e12950/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130180"
}


@Article{info:doi/10.2196/15809,
author="Rind, Esther
and Emerich, Sigrid
and Preiser, Christine
and Tsarouha, Elena
and Rieger, A. Monika
and ",
title="Exploring Drivers of Work-Related Stress in General Practice Teams as an Example for Small and Medium-Sized Enterprises: Protocol for an Integrated Ethnographic Approach of Social Research Methods",
journal="JMIR Res Protoc",
year="2020",
month="Feb",
day="11",
volume="9",
number="2",
pages="e15809",
keywords="occupational health",
keywords="work-related stress",
keywords="small and medium-sized enterprises",
keywords="general practice teams",
keywords="ethnography",
keywords="method triangulation",
keywords="grounded theory",
abstract="Background: An increasing shortage of skilled personnel, including medical personnel, has been reported in many postindustrial economies. Persisting and growing trends in absenteeism and incapacity to work due to mental disorders are concerning and have increased political, economic, and scientific interest in better understanding and management of determinants related to the work environment and health. Objective: This study protocol describes an integrated approach of social research methods to explore determinants of work-related stress in general practice teams as an example for micro, small, and medium-sized enterprises (SMEs). Methods: The methods applied will allow an in-depth exploration of work practices and experiences relating to psychological well-being in general practice teams. An ethnographic approach will be used to develop an in-depth understanding of the drivers of work-related stress in general practice teams. We will combine participating observation and individual interviews with five to seven general practitioners (GPs), and five to seven focus group discussions with the nonphysician staff (3-4 participants per group) in approximately four GP group practices and one single practice in Germany. Data collection and analysis will follow a grounded theory approach. Results: The Ethics Committee of the Medical Faculty, University Hospital of Tuebingen, Germany, has approved this study (reference number: 640/2017BO2). Recruitment has commenced with study completion anticipated in mid-2020. Conclusions: The data from this project will be used in follow-up projects to develop and test an intervention to reduce and prevent work-related stress in GP practices and other SMEs. International Registered Report Identifier (IRRID): DERR1-10.2196/15809 ",
doi="10.2196/15809",
url="https://www.researchprotocols.org/2020/2/e15809",
url="http://www.ncbi.nlm.nih.gov/pubmed/32044759"
}


@Article{info:doi/10.2196/13346,
author="Behrendt, Doerte
and Ebert, Daniel David
and Spiegelhalder, Kai
and Lehr, Dirk",
title="Efficacy of a Self-Help Web-Based Recovery Training in Improving Sleep in Workers: Randomized Controlled Trial in the General Working Population",
journal="J Med Internet Res",
year="2020",
month="Jan",
day="7",
volume="22",
number="1",
pages="e13346",
keywords="occupational health",
keywords="e-mental-health",
keywords="insomnia",
keywords="Web-based, cognitive behavioral therapy",
keywords="mediators",
abstract="Background: Sleep complaints are among the most prevalent health concerns, especially among workers, which may lead to adverse effects on health and work. Internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) offers the opportunity to deliver effective solutions on a large scale. The efficacy of iCBT-I for clinical samples has been demonstrated in recent meta-analyses, and there is evidence that iCBT-I is effective in the working population with severe sleep complaints. However, to date, there is limited evidence from randomized controlled trials that iCBT-I could also be an effective tool for universal prevention among the general working population regardless of symptom severity. Although increasing evidence suggests that negatively toned cognitive activity may be a key factor for the development and maintenance of insomnia, little is known about how iCBT-I improves sleep by reducing presleep cognitive activity. Objective: This study aimed to examine the efficacy of a self-help internet-delivered recovery training, based on principles of iCBT-I tailored to the work-life domain, among the general working population. General and work-related cognitive activities were investigated as potential mediators of the intervention's effect. Methods: A sample of 177 workers were randomized to receive either the iCBT-I (n=88) or controls (n=89). The intervention is a Web-based training consisting of six 1-week modules. As the training was self-help, participants received nothing but technical support via email. Web-based self-report assessments were scheduled at baseline, at 8 weeks, and at 6 months following randomization. The primary outcome was insomnia severity. Secondary outcomes included measures of mental health and work-related health and cognitive activity. In an exploratory analysis, general and work-related cognitive activities, measured as worry and work-related rumination, were investigated as mediators. Results: Analysis of the linear mixed effects model showed that, relative to controls, participants who received iCBT-I reported significantly lower insomnia severity scores at postintervention (between-group mean difference ?4.36; 95\% CI ?5.59 to ? 3.03; Cohen d=0.97) and at 6-month follow-up (between-group difference: ?3.64; 95\% CI ?4.89 to ?2.39; Cohen d=0.86). The overall test of group-by-time interaction was significant (P<.001). Significant differences, with small-to-large effect sizes, were also detected for cognitive activity and for mental and work-related health, but not for absenteeism. Mediation analysis demonstrated that work-related rumination (indirect effect: a1b1=?0.80; SE=0.34; 95\% boot CI ?1.59 to ?0.25) and worry (indirect effect: a2b2=?0.37; SE=0.19; 95\% boot CI ?0.85 to ?0.09) mediate the intervention's effect on sleep. Conclusions: A self-help Web-based recovery training, grounded in the principles of iCBT-I, can be effective in the general working population, both short and long term. Work-related rumination may be a particularly crucial mediator of the intervention's effect, suggesting that tailoring interventions to the workplace, including components to reduce the work-related cognitive activity, might be important when designing recovery interventions for workers. Trial Registration: German Clinical Trials Register DRKS00007142; https://www.drks.de/DRKS00007142 ",
doi="10.2196/13346",
url="https://www.jmir.org/2020/1/e13346",
url="http://www.ncbi.nlm.nih.gov/pubmed/31909725"
}


@Article{info:doi/10.2196/11158,
author="Han, Kyu Min
and Cho, Belong
and Kwon, Hyuktae
and Son, Young Ki
and Lee, Hyejin
and Lee, Kyung Joo
and Park, Jinho",
title="A Mobile-Based Comprehensive Weight Reduction Program for the Workplace (Health-On): Development and Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="4",
volume="7",
number="11",
pages="e11158",
keywords="weight loss programs",
keywords="smartphone",
keywords="mobile phone",
keywords="workplaces",
keywords="obesity",
keywords="obesity management",
abstract="Background: There is a growing interest in mobile technology for obesity management. Despite the known effectiveness of workplace-based weight loss programs, there are few studies on mobile phone--delivered interventions. Objective: This study aimed to develop and verify an integrated and personalized mobile technology--based weight control program, named Health-On, optimized for workplaces. Methods: A weight reduction algorithm was developed for calorie prescription, continuous monitoring, periodic feedback and reevaluation, goal resetting, and offline intervention with behavior-changing strategies. A total of 30 obese volunteers (body mass index ?25 kg/m2) participated in the 12-week Health-On pilot program. The primary outcome was weight reduction, and secondary outcomes were improved anthropometric measures, metabolic profiles, and fat computed tomography measures, all assessed pre- and postintervention. Results: Health-On incorporated proprietary algorithms and several strategies intended to maximize adherence, using compatible online and offline interventions. The mean weight of 30 participants decreased by 5.8\%, and median weight also decreased from 81.3 kg (interquartile range [IQR] 77.1-87.8) before intervention to 76.6 kg (IQR 70.8-79.5) after the 12-week intervention period (P<.001). The metabolic profiles and fat measures (blood pressure, glycosylated hemoglobin, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, alanine aminotransferase, and visceral and subcutaneous adipose tissue; P<.05) also improved significantly. Conclusions: In this single-group evaluation of 30 participants before and after the Health-On program, body weight decreased and metabolic profiles and fat measures improved. Follow-up studies are needed to assess effectiveness and long-term adherence. ",
doi="10.2196/11158",
url="https://mhealth.jmir.org/2019/11/e11158",
url="http://www.ncbi.nlm.nih.gov/pubmed/31682576"
}


@Article{info:doi/10.2196/15303,
author="Pijpker, Roald
and Vaandrager, Lenneke
and Veen, J. Esther
and Koelen, A. Maria",
title="A Salutogenic Approach to Understanding the Potential of Green Programs for the Rehabilitation of Young Employees With Burnout: Protocol for a Mixed Method Study on Effectiveness and Effective Elements",
journal="JMIR Res Protoc",
year="2019",
month="Oct",
day="30",
volume="8",
number="10",
pages="e15303",
keywords="burnout",
keywords="health promotion",
keywords="occupational health",
keywords="program evaluation",
keywords="rehabilitation",
keywords="sense of coherence",
keywords="workforce",
abstract="Background: Burnout is the leading cause of absenteeism in the Netherlands, with associated sick leave costs amounting to around {\texteuro}1.8 billion. Studies have indicated that burnout complaints increased from almost 14.4\% in 2014 to 17.3\% in 2018, especially among employees between the ages of 18 and 35 years, and further increases are expected. Although there are many published articles on burnout, not much is known about what constitutes effective rehabilitation (ie, the reduction of burnout complaints and the facilitation of returning to work). At the same time, multiple pilot studies have indicated that green programs are effective in both reducing burnout complaints and facilitating return to work. Green programs have been developed by professionals experienced in using the natural environment to facilitate rehabilitation (eg, through green exercise and healing gardens). The literature nevertheless lacks comprehensive and contextual insight into what works and why. Objective: The overarching aim of this study is to explore the potential of green programs for young employees with burnout. We present the study protocol from an ongoing research project consisting of 2 phases, each composed of 2 research objectives that sequentially build upon each other. Methods: The study is based on a sequential design with 4 research objectives, using both qualitative and quantitative research methods. In the first phase, a systematic literature review (research objective 1) and in-depth interviews (research objective 2) will be used to explore mechanisms underlying the rehabilitation of young employees with burnout. In the second phase, a multicase study will be conducted to examine the extent to which green programs are built on mechanisms identified in the first phase (research objective 3). By employing a pretest and posttest design, a specific green program that captures most of those mechanisms will then be evaluated on its effect and process with regard to the rehabilitation of young employees with burnout (research objective 4). The project started in June 2018 and will continue through June 2022. Results: The first phase (research objectives 1 and 2) is intended to generate information on the mechanisms underlying the rehabilitation of young employees with burnout. The second phase (research objectives 3 and 4) is designed to demonstrate the extent to which and how the selected green program facilitates the rehabilitation of young employees with burnout. Conclusions: Understanding how green programs can facilitate the rehabilitation of young employees with burnout complaints can help to address this societal issue. International Registered Report Identifier (IRRID): DERR1-10.2196/15303 ",
doi="10.2196/15303",
url="http://www.researchprotocols.org/2019/10/e15303/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31670699"
}


@Article{info:doi/10.2196/14763,
author="Min, Jin-Young
and Song, Sung-Hee
and Kim, HyeJin
and Min, Kyoung-Bok",
title="Mining Hidden Knowledge About Illegal Compensation for Occupational Injury: Topic Model Approach",
journal="JMIR Med Inform",
year="2019",
month="Sep",
day="26",
volume="7",
number="3",
pages="e14763",
keywords="occupational injuries",
keywords="worker's compensation",
keywords="social media",
keywords="Korea",
abstract="Background: Although injured employees are legally covered by workers' compensation insurance in South Korea, some employers make agreements to prevent the injured employees from claiming their compensation. Thus, this leads to underreporting of occupational injury statistics. Illegal compensation (called gong-sang in Korean) is a critical method used to underreport or cover-up occupational injuries. However, gong-sang is not counted in the official occupational injury statistics; therefore, we cannot identify gong-sang--related issues. Objective: This study aimed to analyze social media data using topic modeling to explore hidden knowledge about illegal compensation---gong-sang---for occupational injury in South Korea. Methods: We collected 2210 documents from social media data by filtering the keyword, gong-sang. The study period was between January 1, 2006, and December 31, 2017. After completing natural language processing of the Korean language, a morphological analyzer, we performed topic modeling using latent Dirichlet allocation (LDA) in the Python library, Gensim. A 10-topic model was selected and run with 3000 Gibbs sampling iterations to fit the model. Results: The LDA model was used to classify gong-sang--related documents into 4 categories from a total of 10 topics. Topic 1 was the greatest concern (60.5\%). Workers who suffered from industrial accidents seemed to be worried about illegal compensation and legal insurance claims, wherein keywords on the choice between illegal compensation and legal insurance claims were included. In topic 2, keywords were associated with claims for industrial accident insurance benefits. Topics 3 and 4, as the second highest concern (19\%), contained keywords implying the monetary compensation of gong-sang. Topics 5 to 10 included keywords on vulnerable jobs (ie, workers in the construction and defense industry, delivery riders, and foreign workers) and body parts (ie, injuries to the hands, face, teeth, lower limbs, and back) to gong-sang. Conclusions: We explored hidden knowledge to identify the salient issues surrounding gong-sang using the LDA model. These topics may provide valuable information to ensure the more efficient operation of South Korea's occupational health and safety administration and protect vulnerable workers from illegal gong-sang compensation practices. ",
doi="10.2196/14763",
url="https://medinform.jmir.org/2019/3/e14763",
url="http://www.ncbi.nlm.nih.gov/pubmed/31573948"
}


@Article{info:doi/10.2196/13744,
author="Hopf, B. Nancy
and Bourgkard, Eve
and Demange, Val{\'e}rie
and Hulo, S{\'e}bastien
and Sauvain, Jean-Jacques
and Levilly, Ronan
and Jeandel, Fanny
and Robert, Alain
and Guichard, Yves
and Pralong, Andr{\'e} Jacques
and Ch{\'e}rot-Kornobis, Nathalie
and Edm{\'e}, Jean-Louis
and Wild, Pascal",
title="Early Effect Markers and Exposure Determinants of Metalworking Fluids Among Metal Industry Workers: Protocol for a Field Study",
journal="JMIR Res Protoc",
year="2019",
month="Aug",
day="02",
volume="8",
number="8",
pages="e13744",
keywords="metalworking fluid",
keywords="oxidative stress",
keywords="exposure biomarkers",
keywords="early effect biomarkers",
keywords="genotoxic effects",
keywords="occupational epidemiology",
abstract="Background: Exposure to aerosols from metalworking fluids (MWF) has previously been related to a series of adverse health outcomes (eg, cancer, respiratory diseases). Our present epidemiological study focuses on occupational exposures to MWF and a panel of exposure and effect biomarkers. We hypothesize that these health outcomes are caused by particle exposure that generates oxidative stress, leading to airway inflammation and ultimately to chronic respiratory diseases. We aimed to assess whether MWF exposure, in particular as characterized by its oxidative potential, is associated with biomarkers of oxidative stress and inflammation as well as genotoxic effects. Objective: The ultimate goal is to develop exposure reduction strategies based on exposure determinants that best predict MWF-related health outcomes. The following relationships will be explored: (1) exposure determinants and measured exposure; (2) occupational exposure and preclinical and clinical effect markers; (3) exposure biomarkers and biomarkers of effect in both exhaled breath condensate and urine; and (4) biomarkers of effect, genotoxic effects and respiratory symptoms. Methods: At least 90 workers from France and Switzerland (30 controls, 30 exposed to straight MWF and 30 to aqueous MWF) were followed over three consecutive days after a nonexposed period of at least two days. The exposure assessment is based on MWF, metal, aldehyde, and ultrafine particle number concentrations, as well as the intrinsic oxidative potential of aerosols. Furthermore, exposure biomarkers such as metals, metabolites of polycyclic aromatic hydrocarbons and nitrosamine are measured in exhaled breath condensate and urine. Oxidative stress biomarkers (malondialdehyde, 8-isoprostane, 8-hydroxy-2'-deoxyguanosine, nitrates, and nitrites) and exhaled nitric oxide, an airway inflammation marker, are repeatedly measured in exhaled breath condensate and urine. Genotoxic effects are assessed using the buccal micronucleus cytome assay. The statistical analyses will include modelling exposure as a function of exposure determinants, modelling the evolution of the biomarkers of exposure and effect as a function of the measured exposure, and modelling respiratory symptoms and genotoxic effects as a function of the assessed long-term exposure. Results: Data collection, which occurred from January 2018 until June 2019, included 20 companies. At the date of writing, the study included 100 subjects and 29 nonoccupationally exposed controls. Conclusions: This study is unique as it comprises human biological samples, questionnaires, and MWF exposure measurement. The biomarkers collected in our study are all noninvasive and are useful in monitoring MWF exposed workers. The aim is to develop preventative strategies based on exposure determinants related to health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/13744 ",
doi="10.2196/13744",
url="https://www.researchprotocols.org/2019/8/e13744/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31376276"
}


@Article{info:doi/10.2196/12285,
author="Zwerenz, R{\"u}diger
and Baumgarten, Carlotta
and Dahn, Ingo
and Labitzke, Nicole
and Schwarting, Andreas
and Rudolph, Matthias
and Ferdinand, Peter
and Dederichs-Masius, Ute
and Beutel, E. Manfred",
title="Implementation of a Web-Based Work-Related Psychological Aftercare Program Into Clinical Routine: Results of a Longitudinal Observational Study",
journal="J Med Internet Res",
year="2019",
month="Jun",
day="18",
volume="21",
number="6",
pages="e12285",
keywords="aftercare",
keywords="internet",
keywords="mental health",
keywords="psychotherapeutic processes",
keywords="return to work",
keywords="occupational stress",
keywords="health plan implementation",
abstract="Background: As inpatient medical rehabilitation serves to promote work ability, vocational reintegration is a crucial outcome. However, previous Web-based trials on coping with work-related stress have been limited to Web-based recruitment of study participants. Objective: The aim of our study was to evaluate the implementation of an empirically supported transdiagnostic psychodynamic Web-based aftercare program GSA (Gesund und Stressfrei am Arbeitsplatz [Healthy and stress-less at the workplace])-Online plus into the clinical routine of inpatient medical rehabilitation, to identify characteristics of patients who have received the recommendation for GSA-Online plus, and to determine helpfulness of the intervention and satisfaction of the participants as well as improvement in quality of life and mental health status of the regular users of GSA-Online plus. Methods: GSA-Online plus was prescribed by physicians at termination of orthopedic psychosomatic inpatient rehabilitation. Participants' use of the program, work-related attitudes, distress, and quality of life were assessed on the Web. Results: In 2 rehabilitation centers, 4.4\% (112/2562) of rehabilitants got a recommendation for GSA-Online plus during inpatient rehabilitation. Compared with usual person aftercare, the Web-based aftercare program was rarely recommended by physicians. Recommendations were made more frequently in psychosomatic (69/1172, 5.9\%) than orthopedic (43/1389, 3.1\%) rehabilitation ($\chi$21=11.845, P=.001, Cram{\'e}r V=?0.068) and to younger patients (P=.004, d=0.28) with longer inpatient treatment duration (P<.001, r=?0.12) and extended sick leaves before inpatient medical rehabilitation (P=.004; Cram{\'e}r V=0.072). Following recommendation, 77\% (86/112) of rehabilitants participated in Web-based aftercare. Completers (50/86, 58\%) reported statistically significant improvements between discharge of inpatient treatment and the end of the aftercare program for subjective work ability (P=.02, d=0.41), perceived stress (P=.01, d=?0.38), functioning (P=.002, d=?0.60), and life satisfaction (P=.008, d=0.42). Conclusions: Physicians' recommendations of Web-based aftercare are well accepted by patients who derive considerable benefits from participation. However, a low rate of prescription compared with other usual aftercare options points to barriers among physicians to prescribing Web-based aftercare. ",
doi="10.2196/12285",
url="http://www.jmir.org/2019/6/e12285/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31215515"
}


@Article{info:doi/10.2196/12246,
author="Clarke, Janine
and Sanatkar, Samineh
and Baldwin, Andrew Peter
and Fletcher, Susan
and Gunn, Jane
and Wilhelm, Kay
and Campbell, Lesley
and Zwar, Nicholas
and Harris, Mark
and Lapsley, Helen
and Hadzi-Pavlovic, Dusan
and Christensen, Helen
and Proudfoot, Judy",
title="A Web-Based Cognitive Behavior Therapy Intervention to Improve Social and Occupational Functioning in Adults With Type 2 Diabetes (The SpringboarD Trial): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2019",
month="May",
day="21",
volume="21",
number="5",
pages="e12246",
keywords="type 2 diabetes",
keywords="depression",
keywords="internet",
abstract="Background: Depressive symptoms are common in people with type 2 diabetes mellitus (T2DM). Effective depression treatments exist; however, access to psychological support is characteristically low. Web-based cognitive behavioral therapy (CBT) is accessible, nonstigmatizing, and may help address substantial personal and public health impact of comorbid T2DM and depression. Objective: The aim of this study was to evaluate the Web-based CBT program, myCompass, for improving social and occupational functioning in adults with T2DM and mild-to-moderate depressive symptoms. myCompass is a fully automated, self-guided public health treatment program for common mental health problems. The impact of treatment on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior was also examined. Methods: Participants with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited online via Google and Facebook advertisements targeting adults with T2DM and via community and general practice settings. Screening, consent, and self-report scales were all self-administered online. Participants were randomized using double-blind computerized block randomization to either myCompass (n=391) for 8 weeks plus a 4-week tailing-off period or an active placebo intervention (n=379). At baseline and postintervention (3 months), participants completed the Work and Social Adjustment Scale, the primary outcome measure. Secondary outcome measures included the Patient Health Questionnaire-9 item, Diabetes Distress Scale, Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. Results: myCompass users logged in an average of 6 times and completed an average of .29 modules. Healthy Lifestyles users logged in an average of 4 times and completed an average of 1.37 modules. At baseline, mean scores on several outcome measures, including the primary outcome of work and social functioning, were near to the normal range, despite an extensive recruitment process. Approximately 61.6\% (473/780) of participants completed the postintervention assessment. Intention-to-treat analyses revealed improvement in functioning, depression, anxiety, diabetes distress, and healthy eating over time in both groups. Except for blood glucose monitoring and medication adherence, there were no specific between-group effects. Follow-up analyses suggested the outcomes did not depend on age, morbidity, or treatment engagement. Conclusions: Improvement in social and occupational functioning and the secondary outcomes was generally no greater for myCompass users than for users of the control program at 3 months postintervention. These findings should be interpreted in light of near-normal mean baseline scores on several variables, the self-selected study sample, and sample attrition. Further attention to factors influencing uptake and engagement with mental health treatments by people with T2DM, and the impact of illness comorbidity on patient conceptualization and experience of mental health symptoms, is essential to reduce the burden of T2DM. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12615000931572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109\&isReview=true (Archived by WebCite at http://www.webcitation.org/7850eg8pi) ",
doi="10.2196/12246",
url="http://www.jmir.org/2019/5/e12246/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31115345"
}


@Article{info:doi/10.2196/11401,
author="Wan Mohd Yunus, Azam Wan Mohd
and Musiat, Peter
and Brown, SL June",
title="Evaluating the Feasibility of an Innovative Self-Confidence Webinar Intervention for Depression in the Workplace: A Proof-of-Concept Study",
journal="JMIR Ment Health",
year="2019",
month="Apr",
day="26",
volume="6",
number="4",
pages="e11401",
keywords="online",
keywords="videoconferencing",
keywords="cognitive behavioral therapy",
keywords="depression",
keywords="workplace",
abstract="Background: Depression in the workplace is a very common problem that exacerbates employees' functioning and consequently influences the productivity of organizations. Despite the commonness of the problem and the currently available interventions, a high proportion of employees do not seek help. A new intervention, a webinar (Web-based seminar), was developed, which integrated the use of technology and the traditional guided therapist support to provide accessible help for the problem of depression in the workplace. Objective: The aim of this study was to explore the feasibility, preliminary outcome, and acceptability of the webinar intervention conducted in organizations. Methods: In total, 2 organizations were invited to participate, and 33 employees participated in this proof-of-concept study. The webinar intervention consisted of 6 1-hour sessions conducted via the Adobe Connect platform, developed by Adobe Inc. The intervention was developed based on a systematic review, focus group studies, and face-to-face self-confidence workshops that utilized cognitive behavior therapy (CBT). The final webinar intervention used CBT and the coping flexibility approach. The structure of the intervention included PowerPoint presentations, animation videos, utilization of chat panels, and whiteboard features. The intervention was conducted live and guided by a consultant psychologist assisted by a moderator. Study outcomes were self-assessed using self-reported Web surveys. The acceptability of the intervention was assessed using self-reported user experience Web surveys and open-ended questions. Results: The findings showed: (1) evidence of feasibility of the intervention: the webinar intervention was successfully conducted in 3 groups, with 6 1-hour sessions for each group, with 82\% (23/28) participants completing all 6 sessions; (2) positive improvements in depression: the linear mixed effects modeling analysis recorded a significant overall effect of time primarily for depression (F2, 48.813=31.524; P<.001) with a Hedge g effect size of 0.522 at 1-month follow-up. Individually, 8 subjects showed significant reliable and clinically significant changes, with 3 subjects showing clinically significant change only; and (3) encouraging evidence regarding the acceptability of the webinar intervention among the employees: the user experience score was above average for 4 out of 6 domains measured (perspicuity mean 1.198 [95\% CI 0.832-1.564], efficiency mean 1.000 [95\% CI 0.571-1.429], dependability mean 1.208 [95\% CI 0.899-1.517], and stimulation mean 1.323 [95\% CI 0.987-1.659]). The open-ended questions also yielded 52\% (47/91) of the responses that reported facilitators, whereas only 12\% (11/91) of the responses reported barriers. Conclusions: The self-confidence webinar intervention appears to be a potentially feasible, effective, and acceptable intervention for depression in the workplace that merits further investigation. ",
doi="10.2196/11401",
url="http://mental.jmir.org/2019/4/e11401/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31025943"
}


@Article{info:doi/10.2196/11832,
author="Chan, Renee
and Nguyen, Matthew
and Smith, Rachel
and Spencer, Sarah
and Pit, Winona Sabrina",
title="Effect of Serial Anthropometric Measurements and Motivational Text Messages on Weight Reduction Among Workers: Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="24",
volume="7",
number="4",
pages="e11832",
keywords="text messages",
keywords="obesity",
keywords="waist-hip ratio",
keywords="weight reduction programs",
keywords="mHealth",
abstract="Background: Obesity is an endemic problem with significant health and financial consequences. Text messaging has been shown to be a simple and effective method of facilitating weight reduction. In addition, waist-to-hip ratio (WHR) has emerged as a significant anthropometric measure. However, few studies have examined the effect of serial anthropometric self-measurement combined with text messaging. Objective: The primary aim of this study was to assess whether an 8-week program, consisting of weekly serial self-measurements of waist and hip circumference, combined with motivational text messages, could reduce WHR among Australian workers. Methods: This was a community-based, participant-blinded, staggered-entry, parallel group study. Adult workers with access to mobile phones were eligible and recruited through an open access Web-based survey. Participants were randomly allocated to receive intervention or control messages for 8 weeks. Outcome data were self-assessed through a Web-based survey. Results: A total of 60 participants were randomized with 30 participants each allocated to a control and an intervention group. There was no significant change in WHR (P=.43), and all secondary outcome measures did not differ between the intervention group and the control group at the end of the 8-week intervention. Both groups, however, showed a significant decrease in burnout over time (mean [SE]: pre 4.80 [0.39] vs post 3.36 [0.46]; P=.004). The intervention uptake followed a downward trend. Peak participant replies to weekly self-measurements were received in week 3 (14/23, 61\%) and the least in week 8 (8/23, 35\%). No harm was found to result from this study. Conclusions: This study is an innovative pilot trial using text messaging and serial anthropometric measurements in weight management. No change was detected in WHRs in Australian workers over 8 weeks; therefore, it could not be concluded whether the intervention affected the primary outcome. However, these results should be interpreted in the context of limited sample size and decreasing intervention uptake over the course of the study. This pilot trial is useful for informing and contributing to the design of future studies and the growing body of literature on serial self-measurements combined with text messaging. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001496404; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371696\&isReview=true (Archived by WebCite at http://www.webcitation.org/73UkKFjSw) ",
doi="10.2196/11832",
url="https://mhealth.jmir.org/2019/4/e11832/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31017585"
}


@Article{info:doi/10.2196/11600,
author="Garabiles, R. Melissa
and Harper Shehadeh, Melissa
and Hall, J. Brian",
title="Cultural Adaptation of a Scalable World Health Organization E-Mental Health Program for Overseas Filipino Workers",
journal="JMIR Form Res",
year="2019",
month="Mar",
day="29",
volume="3",
number="1",
pages="e11600",
keywords="cultural adaptation",
keywords="migrant workers",
keywords="e-mental health",
keywords="overseas Filipino workers",
abstract="Background: Electronic mental (e-mental) health interventions can address mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish a better fit with the cultural group and to achieve better treatment outcomes. Objective: This study aimed to describe the cultural adaptation of the World Health Organization's e-mental health program Step-by-Step for overseas Filipino workers. We used a framework which posits that cultural adaptation should enhance (1) relevance, wherein the cultural group can relate with the content; (2) acceptability, where the cultural group will not find any element offensive; (3) comprehensibility, where the program is understandable; and (4) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino and male and female versions. Methods: Overall, 3 experienced Filipino psychologists provided their perspectives on the program and how it might be adapted for overseas Filipino workers. We then adapted the program and obtained feedback from 28 overseas Filipino workers from diverse industries through focus group discussions. We conducted 7 and 9 focus group discussions with male and female participants, respectively. Per discussion, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided iterative program adaptations, which were again shown to participants for validation and improvement. Results: Several issues were raised by participants about the generic version of Step-by-Step. There were elements deemed irrelevant, like unfitting characters, lack of Filipino values, and unsuitable problems and activities. There were unacceptable components that were stigmatizing, political, inappropriate to context or subgroups, and too feminine for male users. Some elements were incomprehensible, unclear, or complicated. To address these issues, we made key adaptations. To enhance relevance, we adapted the narrative to match the experiences of overseas Filipino workers, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), political or unacceptable content was removed, and the program was made suitable for overseas Filipino workers from different sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms, and ensured that text and illustrations matched. We also used Taglish (ie, merged English and Filipino) when participants deemed pure Filipino translations sounded odd or incomprehensible. Finally, we retained the core elements and concepts included in the original Step-by-Step program to maintain completeness. Conclusions: This study showed the utility of a 4-point framework that focuses on acceptance, relevance, comprehensibility, and completeness in cultural adaptation. Moreover, we achieved a culturally appropriate adapted version of the Step-by-Step program for overseas Filipino workers. We discuss lessons learned in the process to guide future cultural adaptation projects of e-mental health interventions. ",
doi="10.2196/11600",
url="https://formative.jmir.org/2019/1/e11600/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30924784"
}


@Article{info:doi/10.2196/11224,
author="Smail-Crevier, Rachel
and Powers, Gabrielle
and Noel, Chelsea
and Wang, JianLi",
title="Health-Related Internet Usage and Design Feature Preference for E-Mental Health Programs Among Men and Women",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="18",
volume="21",
number="3",
pages="e11224",
keywords="occupational health",
keywords="workplace",
keywords="mental health",
keywords="preventive health program",
keywords="depression",
keywords="internet",
abstract="Background: Major depressive episodes (MDEs) are prevalent in the workplace and affect workers' health and productivity. Therefore, there is a pressing need for innovation in the prevention of MDEs in the workplace. Electronic mental (e-mental) health programs are a cost-effective approach toward the self-management of stress and emotional issues. E-mental health dropout rate, MDE prevalence, and symptoms greatly vary by sex and age. Thus, the development and implementation of e-mental health programs for the prevention of MDEs need to be examined through a sex and age lens to enhance program use and effectiveness. Objective: This study aimed to examine design feature preferences based on sex and age for an e-mental health program targeted toward depression prevention. Methods: Household residents across Canada were contacted using the random digit dialing method. 500 women and 511 men who were 18 years and older and who were at high risk of having MDEs were interviewed. Internet use was assessed using questions from the 2012 Canadian Internet Use Survey conducted by Statistics Canada, and preferred design features of e-mental health program questions were developed by the BroMatters team members. The proportions of likely use of specific features of e-mental health programs in women were estimated and compared with those in men using chi-square tests. The comparisons were made overall and by age groups. Results: Men (181/511, 35.4\%) and women (211/500, 42.2\%) differed significantly in their likelihood of using an e-mental health program. Compared with men (307/489, 62.8\%), women (408/479, 85.2\%) were more likely to use the internet for medical or health-related information. Women were more likely to use the following design features: practices and exercises to help reduce symptoms of stress and depression (350/500, 70.7\%), a self-help interactive program that provides information about stress and work problems (302/500, 61.8\%), the ability to ask questions and receive answers from mental health professionals via email or text message (294/500, 59.9\%), and to receive printed materials by mail (215/500, 43.4\%). Men preferred to receive information in a video game format (156/511, 30.7\%). Younger men (46/73, 63\%) and younger women (49/60, 81\%) were more likely to access a program through a mobile phone or an app, and younger men preferred having access to information in a video game format. Conclusions: Factors such as sex and age influenced design feature preferences for an e-mental health program. Working women who are at high risk for MDEs preferred interactive programs incorporating practice and exercise for reducing stress, quality information about work stress, and some guidance from professionals. This suggests that sex and age should be taken into account when designing e-mental health programs to meet the needs of individuals seeking help via Web-based mental health programs and to enhance their use. ",
doi="10.2196/11224",
url="http://www.jmir.org/2019/3/e11224/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30882361"
}


@Article{info:doi/10.2196/12894,
author="Joyce, Sadhbh
and Shand, Fiona
and Lal, J. Tara
and Mott, Brendan
and Bryant, A. Richard
and Harvey, B. Samuel",
title="Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders",
journal="J Med Internet Res",
year="2019",
month="Feb",
day="19",
volume="21",
number="2",
pages="e12894",
keywords="resilience training",
keywords="workplace mental health",
keywords="occupational health",
keywords="well-being",
keywords="online intervention",
keywords="employee resilience",
keywords="health and safety",
keywords="psychological health",
keywords="first responders",
abstract="Background: A growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time. Objective: This study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers. Methods: We conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills. Results: Mixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95\% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002). Conclusions: The results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12615000574549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368296 (Archived by WebCite at http://www.webcitation.org/75w4xtrpw). ",
doi="10.2196/12894",
url="http://www.jmir.org/2019/2/e12894/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30777846"
}


@Article{info:doi/10.2196/11079,
author="Huang, Yitong
and Benford, Steve
and Blake, Holly",
title="Digital Interventions to Reduce Sedentary Behaviors of Office Workers: Scoping Review",
journal="J Med Internet Res",
year="2019",
month="Feb",
day="07",
volume="21",
number="2",
pages="e11079",
keywords="telemedicine",
keywords="sedentary behavior",
keywords="workplace",
keywords="technology",
keywords="internet",
keywords="microcomputers",
abstract="Background: There is a clear public health need to reduce office workers' sedentary behaviors (SBs), especially in the workplace. Digital technologies are increasingly being deployed in the workplace to measure and modify office workers' SBs. However, knowledge of the range and nature of research on this topic is limited; it also remains unclear to what extent digital interventions have exploited the technological possibilities. Objective: This study aimed to investigate the technological landscape of digital interventions for SB reduction in office workers and to map the research activity in this field. Methods: Terms related to SB, office worker, and digital technology were applied in various combinations to search Cochrane Library, Joanna Briggs Institute Database of Systematic Reviews, MEDLINE, PsycARTICLES, PsycINFO, Scopus, Association for Computing Machinery Digital Library, Engineering index Compendex, and Google Scholar for the years 2000 to 2017. Data regarding the study and intervention details were extracted. Interventions and studies were categorized into development, feasibility and/piloting, evaluation, or implementation phase based on the UK Medical Research Council (MRC) framework for developing and evaluating complex interventions. A novel framework was developed to classify technological features and annotate technological configurations. A mix of quantitative and qualitative approaches was used to summarize data. Results: We identified 68 articles describing 45 digital interventions designed to intervene with office workers' SB. A total of 6 common technological features had been applied to interventions with various combinations. Configurations such as ``information delivery and mediated organizational and social support'' and ``digital log and automated tailored feedback'' were well established in evaluation and implementation studies; in contrast, the integration of passive data collection, connected devices, and ATF or scheduled prompts was mostly present in development and piloting research. Conclusions: This review is the first to map and describe the use of digital technologies in research on SB reduction in office workers. Interdisciplinary collaborations can help to maximize the potential of technologies. As novel modes of delivery that capitalize on embedded computing and electronics, wireless technologies have been developed and piloted in engineering, computing, and design fields, efforts can be directed to move them to the next phase of evaluation with more rigorous study designs. Quality of research may be improved by fostering conversations between different research communities and encouraging researchers to plan, conduct, and report their research under the MRC framework. This review will be particularly informative to those deciding on areas where further research or development is needed and to those looking to locate the relevant expertise, resources, and design inputs when designing their own systems or interventions. ",
doi="10.2196/11079",
url="http://www.jmir.org/2019/2/e11079/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30730294"
}


@Article{info:doi/10.2196/jmir.9711,
author="Weichelt, Bryan
and Bendixsen, Casper
and Keifer, Matthew",
title="Farm Owners and Workers as Key Informants in User-Centered Occupational Health Prototype Development: A Stakeholder-Engaged Project",
journal="J Med Internet Res",
year="2019",
month="Jan",
day="29",
volume="21",
number="1",
pages="e9711",
keywords="agriculture",
keywords="farmworkers",
keywords="injuries",
keywords="occupational medicine",
keywords="return to work",
keywords="software application",
abstract="Background: The cost of workplace injuries and illnesses significantly impacts the overall cost of health care and is a significant annual economic burden in the United States. Many dairy and pork farm owners in the Upper Midwest have expanded operations and taken on the role of manager and employer yet receive little training in injury prevention, farm safety, or workers' compensation programs and processes. Clinicians play a key role in the return to work of injured and ill farmers and farmworkers to their jobs, though little to no formal training is offered by medical schools. Objective: This stakeholder-engaged project aimed to develop a prototype application designed to assist clinicians in returning injured farmworkers to light-duty job assignments with their current employers and to assess farm owners' and managers' attitudes toward and barriers to adopting mobile health tools for themselves or their employees. Methods: We conducted 12 semistructured interviews with English-speaking farm owners and farmworkers from the Upper Midwest: 5 English-speaking and Spanish-speaking farmworker focus groups and 8 postproject interviews with farm owners that focused on attitudes and barriers to adoption of the developed software. Interviews and focus groups were audio recorded, and data were analyzed and thematically coded using audio coding. Results: Interviews and worker focus groups guided an iterative design and development cycle, which informed workflow design, button placement, and output sheets that offer specific light-duty farm work recommendations for the injured worker to discuss with his or her employer. Conclusions: The development of a complex prototype intended to impact patient care is a significant undertaking. Reinventing a paper-based process that can eventually integrate with an electronic health record or a private company's human resources system requires substantial stakeholder input from each facet including patients, employers, and clinical care teams. The prototype is available for testing, but further research is needed in the form of clinical trials to assess the effectiveness of the process and the software's impact on patients and employers. ",
doi="10.2196/jmir.9711",
url="https://www.jmir.org/2019/1/e9711/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30694202"
}


@Article{info:doi/10.2196/10272,
author="Brandt, Mikkel
and Madeleine, Pascal
and Samani, Afshin
and Ajslev, ZN Jeppe
and Jakobsen, D. Markus
and Sundstrup, Emil
and Andersen, L. Lars",
title="Effects of a Participatory Ergonomics Intervention With Wearable Technical Measurements of Physical Workload in the Construction Industry: Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Dec",
day="19",
volume="20",
number="12",
pages="e10272",
keywords="back pain",
keywords="low back pain",
keywords="shoulder pain",
keywords="musculoskeletal pain",
keywords="musculoskeletal diseases",
keywords="occupational health",
keywords="building industry",
keywords="heavy industries",
keywords="organizational ergonomics",
keywords="action research",
abstract="Background: Construction work frequently involves heavy physical work, and a reduction of the physical workload should have high priority. Technological development has made it possible to obtain field measurements with surface electromyography (sEMG), kinematics measured with inertial measurement units (IMUs), and video recordings. However, no studies have used these methods simultaneously to detect situations with excessive physical workload (events) during a working day. Thus, knowledge about these specific events may combat work-related risk factors. Participatory ergonomics (PE) has shown promising results, but whether it can be used as a tool to reduce the physical workload during construction work remains unknown. Objective: This cluster randomized controlled trial investigated whether a PE intervention with technical measurements consisting of IMUs, sEMG, heart rate monitoring, and video recordings of physical workload could reduce the number of events with excessive physical workload during a working day. Furthermore, other outcomes were obtained from questionnaires. Methods: A total of 80 male full-time construction workers (aged 19 to 67 years) were randomized at the cluster level (gang) to a PE intervention consisting of 3 workshops (7 gangs and 32 workers) or to a control group (8 gangs and 48 workers). The physical workload was recorded by technical measurements, that is, IMUs, sEMG, heart rate monitoring, and video recordings during a full working day at baseline and 3 and 6 months' follow-up. On the basis of the technical measurements, a custom-made computer program detected the situations (events) where the construction workers were exposed to excessive physical workload and used in the intervention. Differences in the number of events from baseline to follow-up between intervention and control were evaluated using linear mixed models (intention-to-treat), with individual nested in cluster as a random factor. Furthermore, questionnaires were filled out on test days. Results: The results of the primary outcome showed no change in the number of events with excessive physical workload. However, compared with the control group, the other outcomes showed decreased general fatigue after a typical working day (P=.001) and increased influence on own work (P=.04). Conclusions: This PE intervention with technical measurements did not reduce the number of events with excessive physical workload during construction work. However, the intervention led to decreased general fatigue and increased influence on own work. Trial Registration: ClinicalTrials.gov NCT02498197; https://clinicaltrials.gov/ct2/show/NCT02498197 (Archived by WebCite at http://www.webcitation.org/74SZ3DIWS) ",
doi="10.2196/10272",
url="https://www.jmir.org/2018/12/e10272/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30567694"
}


@Article{info:doi/10.2196/10215,
author="Wilbur, Elizabeth Rachel
and Griffin, Spencer Jacob
and Sorensen, Mark
and Furberg, Daniel Robert",
title="Establishing Digital Biomarkers for Occupational Health Assessment in Commercial Salmon Fishermen: Protocol for a Mixed-Methods Study",
journal="JMIR Res Protoc",
year="2018",
month="Dec",
day="10",
volume="7",
number="12",
pages="e10215",
keywords="digital health",
keywords="digital biomarkers",
keywords="occupational health",
keywords="health and safety",
keywords="fishermen",
keywords="physiological health",
keywords="stress",
abstract="Background: Commercial salmon fishing in Alaska is one of the most dangerous occupations in the United States. Between 1992 and 2008, the average annual industry mortality rate was 128 deaths per 100,000 workers, and despite an increase in industry regulations, there has not been a significant decrease in mortality rate since 2000. Unpredictable fishing openings and fierce competition for limited resources result in periods of intense sleep deprivation and physical strain during the short commercial salmon season in Alaska. Objective: We hypothesize that the combined effect of sleep deprivation, intense physical workload, and significant short-term chronic stress may be deleterious to health in both the short- and long-term among commercial salmon drift gillnet fishermen in Alaska. The objective of this protocol is to determine the feasibility of the study design to test this hypothesis. Methods: The study design uses mixed methods and includes biometric monitoring consisting of heart rate variability, respiration, and movement data collected via a personal, wearable biometric device. Additional methods include observational data on activity, including duration and quality of sleep, weather, catch, and financial gain, as well as the collection of salivary cortisol. As such, the study will provide a holistic assessment of individual stress on multiple simultaneous timescales: immediately and continuously through the personal wearable biometric device, on the minute-hour level through the multiple daily collections of salivary cortisol, and by the hour-day through the use of participant and environment observational data. Results: Data collection was initiated in July 2017 and will extend through August 2019. Initial data collection has indicated that the methods outlined in this protocol are feasible and allow for effective collection of qualitative and quantitative data related to the psychological and physiological impact of Alaska commercial salmon fishing. Conclusions: We anticipate that the use of a biometric device will be crucial in establishing measures of stress and physical activity within a population and environment uniquely challenged by physical isolation, strong weather patterns, and the potential for significant financial gain by fishermen. The potential exists for individuals engaged long-term in the fishing industry, through repeated and extended exposure to periods of intense sleep deprivation and chronic stress, to be at increased risk of cardiovascular disease. International Registered Report Identifier (IRRID): DERR1-10.2196/10215 ",
doi="10.2196/10215",
url="http://www.researchprotocols.org/2018/12/e10215/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30530453"
}


@Article{info:doi/10.2196/11661,
author="Deady, Mark
and Johnston, David
and Milne, David
and Glozier, Nick
and Peters, Dorian
and Calvo, Rafael
and Harvey, Samuel",
title="Preliminary Effectiveness of a Smartphone App to Reduce Depressive Symptoms in the Workplace: Feasibility and Acceptability Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Dec",
day="04",
volume="6",
number="12",
pages="e11661",
keywords="depression",
keywords="workplace",
keywords="mHealth",
keywords="smartphone",
keywords="eHealth",
keywords="pilot",
abstract="Background: The workplace represents a unique setting for mental health interventions. Due to range of job-related factors, employees in male-dominated industries are at an elevated risk. However, these at-risk groups are often overlooked. HeadGear is a smartphone app--based intervention designed to reduce depressive symptoms and increase well-being in these populations. Objective: This paper presents the development and pilot testing of the app's usability, acceptability, feasibility, and preliminary effectiveness. Methods: The development process took place from January 2016 to August 2017. Participants for prototype testing (n=21; stage 1) were recruited from industry partner organizations to assess acceptability and utility. A 5-week effectiveness and feasibility pilot study (n=84; stage 2) was then undertaken, utilizing social media recruitment. Demographic data, acceptability and utility questionnaires, depression (Patient Health Questionnaire-9), and other mental health measures were collected. Results: The majority of respondents felt HeadGear was easy to use (92\%), easily understood (92\%), were satisfied with the app (67\%), and would recommend it to a friend (75\%; stage 1). Stage 2 found that compared with baseline, depression and anxiety symptoms were significantly lower at follow-up (t30=2.53; P=.02 and t30=2.18; P=.04, respectively), days of sick leave in past month (t28=2.38; P=.02), and higher self-reported job performance (t28=?2.09; P=.046; stage 2). Over 90\% of respondents claimed it helped improve their mental fitness, and user feedback was again positive. Attrition was high across the stages. Conclusions: Overall, HeadGear was well received, and preliminary findings indicate it may provide an innovative new platform for improving mental health outcomes. Unfortunately, attrition was a significant issue, and findings should be interpreted with caution. The next stage of evaluation will be a randomized controlled trial. If found to be efficacious, the app has the potential to reduce disease burden and improve health in this at-risk group. ",
doi="10.2196/11661",
url="https://mhealth.jmir.org/2018/12/e11661/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30514694"
}


@Article{info:doi/10.2196/jmir.9689,
author="Sendall, C. Marguerite
and McCosker, K. Laura
and Crane, Phil
and Rowland, Bevan
and Fleming, Marylou
and Biggs, C. Herbert",
title="Using Facebook for Health Promotion in ``Hard-to-Reach'' Truck Drivers: Qualitative Analysis",
journal="J Med Internet Res",
year="2018",
month="Nov",
day="01",
volume="20",
number="11",
pages="e286",
keywords="communication",
keywords="health promotion interventions",
keywords="mobile phone",
keywords="social media",
keywords="transport industry",
keywords="truck drivers",
keywords="workplace health promotion",
keywords="workplace managers",
abstract="Background: Workers in the road transport industry, and particularly truck drivers, are at increased risk of chronic diseases. Innovative health promotion strategies involving technologies such as social media may engage this ``hard-to-reach'' group. There is a paucity of evidence for the efficacy of social media technologies for health promotion in the Australian transport industry. Objective: This study analyzed qualitative data from interviews and focus group discussions to evaluate a social media health promotion intervention, the Truckin' Healthy Facebook webpage, in selected Australian transport industry workplaces. Methods: We engaged 5 workplace managers and 30 truck drivers from 6 transport industry organizations in developing workplace health promotion strategies, including a social media intervention, within a Participatory Action Research approach. Mixed methods, including a pre- and postintervention manager survey, truck driver survey, key informant semistructured interviews, truck driver focus groups, and focused observation, were used to evaluate the social media intervention. We asked questions about workplace managers' and truck drivers' opinions, engagement, and satisfaction with the intervention. This paper focuses on qualitative data. Results: Of the workplace managers who reported implementing the social media intervention at their workplace, all (3/3, 100\%) reported satisfaction with the intervention and expressed a keen interest in learning more about social media and how it may be used for workplace health promotion and other purposes. Truck drivers were poorly engaged with the intervention because (1) many believed they were the ``wrong age'' and lacked the necessary skills; (2) the cost of smartphone technology was prohibitive; (3) they confined their use of social media to nonwork-related purposes; and (4) many workplaces had ``no Facebook'' policies. Conclusions: The use of social media as a health promotion intervention in transport industry workplaces has potential. Workplace interventions using social media can benefit from a Participatory Action Research approach. Involving managers and workers in the design of social media health promotion interventions and developing strategies to support and deliver the interventions helps to facilitate their success. The workers' profile, including their age and familiarity with social media, and work, workplace, and family context is important to consider in this process. Much more research needs to be undertaken to better understand the effective use of social media to engage ``hard-to-reach'' groups. ",
doi="10.2196/jmir.9689",
url="https://www.jmir.org/2018/11/e286/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30389653"
}


@Article{info:doi/10.2196/11383,
author="Nicholson, Joanne
and Wright, M. Spenser
and Carlisle, M. Alyssa
and Sweeney, Ann Mary
and McHugo, J. Gregory",
title="The WorkingWell Mobile Phone App for Individuals With Serious Mental Illnesses: Proof-of-Concept, Mixed-Methods Feasibility Study",
journal="JMIR Ment Health",
year="2018",
month="Oct",
day="25",
volume="5",
number="4",
pages="e11383",
keywords="mHealth",
keywords="mobile apps",
keywords="mental disorders",
keywords="employment",
abstract="Background: The disparities in employment for individuals with serious mental illnesses have been well documented, as have the benefits of work. Mobile technology can provide accessible in-the-moment support for these individuals. The WorkingWell mobile app was developed to meet the need for accessible follow-along supports for individuals with serious mental illnesses in the workplace. Objective: We explore the usability, usage, usefulness, and overall feasibility of the WorkingWell mobile app with individuals with serious mental illnesses who are actively employed and receiving community-based services. Methods: In this proof-of-concept, mixed-methods, 2-month feasibility study (N=40), employed individuals with serious mental illnesses were recruited in mental health agencies. Participants completed surveys regarding background characteristics and cellphone use at enrollment and responded to interview items regarding app usability, usage, and usefulness in technical assistance calls at 1, 2, 4, and 6 weeks of participation and in the exit interview at 8 weeks. Data on the frequency of app usage were downloaded on a daily basis. A version of the System Usability Scale (SUS) was administered in the exit interview. Overall feasibility was determined by the percent of users completing the study, responses to an interview item regarding continued use, and findings on usability, usage, and usefulness. General impressions were obtained from users regarding user support materials, technical assistance, and study procedures. Results: Most participants were male (60\%, 24/40), aged 55 or younger (70\%, 28/40), white (80\%, 32/40), had less than a 4-year college education (78\%, 31/40), were employed part-time (98\%, 39/40), had been working more than 6 months (60\%, 24/40), and indicated a diagnosis of bipolar, schizoaffective, or depressive disorder (84\%, 16/25). The majority of participants owned cellphones (95\%, 38/40) and used them multiple times per day (83\%, 33/40). Their average rating on SUS usability items was 3.93 (SD 0.77, range 1.57-5.00), reflecting positive responses. In general, participants indicated WorkingWell was ``very easy,'' ``straightforward,'' ``simple,'' and ``user friendly.'' Usability challenges were related to personal issues (eg, memory) or to difficulties with the phone or app. Data on app usage varied considerably. The most frequent navigations were to the home screen, followed by Rate My Day and My Progress, and then by Manage the Moment and Remind Me. The app was described as useful by most participants; 86\% (30/35) agreed the app would help them manage better on the job. Of the 40 original participants, 35 (87\%) completed the study. Conclusions: The WorkingWell app is a feasible approach to providing accessible, as-needed employment support for individuals with serious mental illnesses. The app would benefit from modifications to address recommendations from feasibility testing. Controlled research with larger samples, more diverse in individual characteristics and workplace settings, is essential to demonstrating the effectiveness of the app. ",
doi="10.2196/11383",
url="http://mental.jmir.org/2018/4/e11383/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30361199"
}


@Article{info:doi/10.2196/10821,
author="Notenbomer, Annette
and Roelen, Corn{\'e}
and Groothoff, Johan
and van Rhenen, Willem
and B{\"u}ltmann, Ute",
title="Effect of an eHealth Intervention to Reduce Sickness Absence Frequency Among Employees With Frequent Sickness Absence: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Oct",
day="23",
volume="20",
number="10",
pages="e10821",
keywords="occupational health",
keywords="sick leave",
keywords="randomized controlled trial",
keywords="adult",
keywords="occupational health physicians",
keywords="eHealth",
abstract="Background: Frequent sickness absence---that is, 3 or more episodes of sickness absence in 1 year---is a problem for employers and employees. Many employees who have had frequent sickness absence in a prior year also have frequent sickness absence in subsequent years: 39\% in the first follow-up year and 61\% within 4 years. Moreover, 19\% have long-term sickness absence (?6 weeks) in the first follow-up year and 50\% within 4 years. We developed an electronic health (eHealth) intervention, consisting of fully automated feedback and advice, to use either as a stand-alone tool (eHealth intervention--only) or combined with consultation with an occupational physician (eHealth intervention--occupational physician). Objective: This study aimed to evaluate the effect of the eHealth intervention, with or without additional occupational physician consultation, to reduce sickness absence frequency for employees with frequent sickness absence, versus care as usual (CAU). Methods: This study was a three-armed randomized controlled trial. Employees with frequent sickness absence received invitational letters, which were distributed by their employers. The primary outcome measure was the number of register-based sickness absence episodes 12 months after completing the baseline questionnaire. Secondary outcome measures were register-based total sickness absence days and self-assessed burnout, engagement, and work ability. In a process evaluation 3 months after baseline, we examined adherence to the intervention and additional actions such as general practitioner and occupational physician visit, communication with the manager, and lifestyle change. Results: A total of 82 participants were included in the analyses, 21 in the eHealth intervention--only group, 31 in the eHealth intervention--occupational physician group, and 30 in the CAU group. We found no significant difference in sickness absence frequency between the groups at 1-year follow-up. Sickness absence frequency decreased in the eHealth intervention--only group from 3 (interquartile range, IQR 3-4) to 1 episode (IQR 0.3-2.8), in the eHealth intervention--occupational physician group from 4 (IQR 3-5) to 3 episodes (IQR 1-4), and in the CAU group from 3 (IQR 3-4) to 2 episodes (IQR 1-3). For secondary outcomes, we found no significant differences between the intervention groups and the control group. The process evaluation showed that only 3 participants from the eHealth intervention--occupational physician group visited the occupational physician on invitation. Conclusions: Among employees with frequent sickness absence, we found no effect from the eHealth intervention as a stand-alone tool in reducing sickness absence frequency, nor on total sickness absence days, burnout, engagement, or work ability. This might be due to low adherence to the intervention because of insufficient urgency to act. We cannot draw any conclusion on the effect of the eHealth intervention tool combined with an occupational physician consultation (eHealth intervention--occupational physician), due to very low adherence to the occupational physician consultation. An occupational physician consultation could increase a sense of urgency and lead to more focus and appropriate support. As this was the first effectiveness study among employees with frequent sickness absence, strategies to improve recruitment and adherence in occupational eHealth are included. Trial Registration: Netherlands Trial Register NTR4316; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4316 (Archived by WebCite at http://www.webcitation.org/713DHhOFU). ",
doi="10.2196/10821",
url="http://www.jmir.org/2018/10/e10821/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30355551"
}


@Article{info:doi/10.2196/10760,
author="Kim, Inyang Johanna
and Yun, Je-Yeon
and Park, Heyeon
and Park, Suk-Young
and Ahn, Youngsheen
and Lee, Hansol
and Kim, Tae-Kwon
and Yoon, Sooran
and Lee, Young-Joon
and Oh, Sohee
and Denninger, W. John
and Kim, Bung-Nyun
and Kim, Jeong-Hyun",
title="A Mobile Videoconference-Based Intervention on Stress Reduction and Resilience Enhancement in Employees: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Oct",
day="22",
volume="20",
number="10",
pages="e10760",
keywords="employees",
keywords="mobile phone",
keywords="randomized controlled trial",
keywords="resilience enhancement",
keywords="stress reduction",
keywords="videoconferencing",
abstract="Background: Videoconferencing-based treatments have shown great potential in increasing engagement and compliance by decreasing the barriers of time and distance. In general, employees tend to experience a lot of stress, but find it difficult to visit a clinic during office hours. Objective: The purpose of this study was to investigate the effectiveness of a mobile videoconference-based intervention for stress reduction and resilience enhancement in employees. Methods: In total, 81 participants were randomly allocated to one of the three conditions: mobile videoconferencing, in-person, and self-care; of these, 72 completed the study. All participants underwent assessment via self-reported questionnaires before, immediately after, and 1 month after the intervention. Intervention lasted for 4 weeks and consisted of elements of cognitive behavioral therapy, positive psychology, and meditation. Changes in clinical variables regarding stress and resilience across time were compared between treatment conditions. Results: There were significant condition {\texttimes} time effects on variables measuring perceived stress, resilience, emotional labor, and sleep, demonstrating significantly differential effects across time according to treatment condition. Moreover, there were significant effects of condition on perceived stress and occupational stress. There were no significant differences in any variable between the mobile videoconferencing and in-person conditions at 1 month after the intervention. Conclusions: Results indicate that both mobile videoconferencing and in-person interventions were comparably effective in decreasing stress and enhancing resilience. Further studies with a larger sample size and a longer follow-up period are warranted to investigate the long-term effect of mobile videoconferencing interventions. Trial Registration: ClinicalTrials.gov identifier NCT03256682; https://clinicaltrials.gov/ct2/show/NCT03256682 (Archived by WebCite at http://www.webcitation.org/71W77bwnR) ",
doi="10.2196/10760",
url="http://www.jmir.org/2018/10/e10760/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30348630"
}


@Article{info:doi/10.2196/jmir.9058,
author="Meyer, Denny
and Jayawardana, W. Madawa
and Muir, D. Samuel
and Ho, Yen-Teh David
and Sackett, Olivia",
title="Promoting Psychological Well-Being at Work by Reducing Stress and Improving Sleep: Mixed-Methods Analysis",
journal="J Med Internet Res",
year="2018",
month="Oct",
day="19",
volume="20",
number="10",
pages="e267",
keywords="exercise",
keywords="productivity",
keywords="healthy lifestyle",
abstract="Background: Workplace programs designed to improve the health and psychological well-being of employees are becoming increasingly popular. However, there are mixed reports regarding the effectiveness of such programs and little analysis of what helps people to engage with such programs. Objective: This evaluation of a particularly broad, team-based, digital health and well-being program uses mixed methods to identify the elements of the program that reduce work stress and promote psychological well-being, sleep quality, and productivity of employees. Methods: Participation in the Virgin Pulse Global Challenge program during May to September 2016 was studied. Self-reported stress, sleep quality, productivity, and psychological well-being data were collected both pre- and postprogram. Participant experience data were collected through a third final survey. However, the response rates for the last 2 surveys were only 48\% and 10\%, respectively. A random forest was used to estimate the probability of the completion of the last 2 surveys based on the preprogram assessment data and the demographic data for the entire sample (N=178,350). The inverse of these estimated probabilities were used as weights in hierarchical linear models in an attempt to address any estimation bias caused by the low response rates. These linear models described changes in psychological well-being, stress, sleep, and productivity over the duration of the program in relation to gender and age, engagement with each of the modules, each of the program features, and participant descriptions of the Virgin Pulse Global Challenge. A 0.1\% significance level was used due to the large sample size for the final survey (N=18,653). Results: The final analysis suggested that the program is more beneficial for older people, with 2.9\% greater psychological well-being improvements observed on average in the case of women than men (P<.001). With one exception, all the program modules contributed significantly to the outcome measures with the following average improvements observed: psychological well-being, 4.1\%-6.0\%; quality of sleep, 3.2\%-6.9\%; work-related stress, 1.7\%-6.8\%; and productivity, 1.9\%-4.2\%. However, only 4 of the program features were found to have significant associations with the outcome measures with the following average improvements observed: psychological well-being, 3.7\%-5.6\%; quality of sleep, 3.4\%-6.5\%; work-related stress, 4.1\%-6.4\%; and productivity, 1.6\%-3.2\%. Finally, descriptions of the Virgin Pulse Global Challenge produced 5 text topics that were related to the outcome measures. Healthy lifestyle descriptions showed a positive association with outcomes, whereas physical activity and step count tracking descriptions showed a negative association with outcomes. Conclusions: The complementary use of qualitative and quantitative survey data in a mixed-methods analysis provided rich information that will inform the development of this and other programs designed to improve employee health. However, the low response rates and the lack of a control group are limitations, despite the attempts to address these problems in the analysis. ",
doi="10.2196/jmir.9058",
url="https://www.jmir.org/2018/10/e267/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30341045"
}


@Article{info:doi/10.2196/mhealth.6363,
author="de Korte, Elsbeth
and Wiezer, Noortje
and Bakhuys Roozeboom, Maartje
and Vink, Peter
and Kraaij, Wessel",
title="Behavior Change Techniques in mHealth Apps for the Mental and Physical Health of Employees: Systematic Assessment",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Oct",
day="03",
volume="6",
number="10",
pages="e167",
keywords="behavior change techniques",
keywords="mHealth",
keywords="mental health",
keywords="physical health",
keywords="lifestyle",
keywords="workplace",
keywords="app",
keywords="employee",
keywords="work",
abstract="Background: Employees remain at risk of developing physical and mental health problems. To improve the lifestyle, health, and productivity many workplace interventions have been developed. However, not all of these interventions are effective. Mobile and wireless technology to support health behavior change (mobile health [mHealth] apps) is a promising, but relatively new domain for the occupational setting. Research on mHealth apps for the mental and physical health of employees is scarce. Interventions are more likely to be useful if they are rooted in health behavior change theory. Evaluating the presence of specific combinations of behavior change techniques (BCTs) in mHealth apps might be used as an indicator of potential quality and effectiveness. Objective: The aim of this study was to assess whether mHealth apps for the mental and physical health of employees incorporate BCTs and, if so, which BCTs can be identified and which combinations of BCTs are present. Methods: An assessment was made of apps aiming to reduce the risk of physical and psychosocial work demands and to promote a healthy lifestyle for employees. A systematic search was performed in iTunes and Google Play. Forty-five apps were screened and downloaded. BCTs were identified using a taxonomy applied in similar reviews. The mean and ranges were calculated. Results: On average, the apps included 7 of the 26 BCTs (range 2-18). Techniques such as ``provide feedback on performance,'' ``provide information about behavior-health link,'' and ``provide instruction'' were used most frequently. Techniques that were used least were ``relapse prevention,'' ``prompt self-talk,'' ``use follow-up prompts,'' and ``provide information about others' approval.'' ``Stress management,'' ``prompt identification as a role model,'' and ``agree on behavioral contract'' were not used by any of the apps. The combination ``provide information about behavior-health link'' with ``prompt intention formation'' was found in 7/45 (16\%) apps. The combination ``provide information about behavior-health link'' with ``provide information on consequences,'' and ``use follow-up prompts'' was found in 2 (4\%) apps. These combinations indicated potential effectiveness. The least potentially effective combination ``provide feedback on performance'' without ``provide instruction'' was found in 13 (29\%) apps. Conclusions: Apps for the occupational setting might be substantially improved to increase potential since results showed a limited presence of BCTs in general, limited use of potentially successful combinations of BCTs in apps, and use of potentially unsuccessful combinations of BCTs. Increasing knowledge on the effectiveness of BCTs in apps might be used to develop guidelines for app developers and selection criteria for companies and individuals. Also, this might contribute to decreasing the burden of work-related diseases. To achieve this, app developers, health behavior change professionals, experts on physical and mental health, and end-users should collaborate when developing apps for the working context. ",
doi="10.2196/mhealth.6363",
url="https://mhealth.jmir.org/2018/10/e167/"
}


@Article{info:doi/10.2196/formative.9343,
author="Healy, Nissa Genevieve
and Eakin, G. Elizabeth
and Winkler, AH Elisabeth
and Hadgraft, Nyssa
and Dunstan, W. David
and Gilson, D. Nicholas
and Goode, D. Ana",
title="Assessing the Feasibility and Pre-Post Impact Evaluation of the Beta (Test) Version of the BeUpstanding Champion Toolkit in Reducing Workplace Sitting: Pilot Study",
journal="JMIR Formativ Res",
year="2018",
month="Aug",
day="28",
volume="2",
number="2",
pages="e17",
keywords="BeUpstanding Champion Toolkit",
keywords="implementation",
keywords="physical activity",
keywords="sedentary",
keywords="workplace sitting",
abstract="Background: The Web-based, evidence-informed BeUpstanding Champion Toolkit was developed to provide employers (via a ``train-the-champion approach'') with resources and support to help in reducing prolonged sitting in their own desk-based workplace. As part of a five-phase research-to-dissemination process, this study reports on the evaluation of the beta (test) version of this toolkit (Phase 2). Objective: The objective of our study was to evaluate (1) the implementation of the toolkit by workplace champions and (2) the impact of the toolkit on sitting (primary outcome), standing, and moving; use of activity-promoting strategies; knowledge and attitudes; and indicators of health and work performance. Methods: An implementation study using a pre-post design was conducted in 7 desk-based workplaces in Australia (September 2015 to May 2016), with work teams (one per workplace) purposively recruited to ensure representation across a range of sectors (white- or blue-collar), organizational sizes (small or medium or large), and locations (metropolitan or regional). All staff within participating teams were invited to participate in the relevant toolkit activities. Implementation outcomes (time commitment required by champions and toolkit activities completed) were collected from each champion via telephone interviews. Changes in impact outcomes, measured via a Web-based questionnaire completed by employees at baseline and 3 months postimplementation, were assessed using mixed models, correcting for clustering. Results: Champions reported a 30-60 minutes per week time commitment to the toolkit activities. All teams formed a wellbeing committee and sent the staff surveys at both time points; most champions held a staff consultation workshop (6/7), identified team-level strategies within that workshop (5/7), used the communication resources provided within the toolkit (emails, posters; 6/7), and completed the action plan (5/7). In total, 52\% (315 of ?600) employees participated in at least one survey and 97 (16\%) participated in both. At follow-up, there was a significant (P<.05) reduction in self-reported workplace sitting time compared to baseline (?6.3\%, 95\% CI ?10.1 to ?2.5; n=85) equating to ?30 minutes per workday. Significant benefits were also observed for the use of activity-promoting strategies, with small, nonsignificant changes observed for knowledge and attitudes and indicators of health and work performance. Conclusions: The beta version of the BeUpstanding Champion Toolkit was feasible to implement and effective in reducing self-reported workplace sitting across a broad range of desk-based workplaces. The next phase (Phase 3) will build on these findings to optimize the toolkit for wider-scale implementation and longer term evaluation. ",
doi="10.2196/formative.9343",
url="http://formative.jmir.org/2018/2/e17/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30684420"
}


@Article{info:doi/10.2196/10231,
author="Imamura, Kotaro
and Furukawa, A. Toshi
and Matsuyama, Yutaka
and Shimazu, Akihito
and Kuribayashi, Kazuto
and Kasai, Kiyoto
and Kawakami, Norito",
title="Differences in the Effect of Internet-Based Cognitive Behavioral Therapy for Improving Nonclinical Depressive Symptoms Among Workers by Time Preference: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Aug",
day="10",
volume="20",
number="8",
pages="e10231",
keywords="internet-based computerized cognitive behavioral therapy",
keywords="time preference",
keywords="nonclinical depressive symptoms",
keywords="workers",
abstract="Background: Previous randomized controlled trials (RCTs) have shown a significant intervention effect of internet-based computerized cognitive behavioral therapy (iCBT) on improving nonclinical depressive symptoms among healthy workers and community residents in a primary prevention setting. Time preference is one's relative valuation for having a reward (eg, money) at present than at a later date. Time preference may affect the effectiveness of cognitive behavioral therapy. Objective: This RCT aimed to test the difference of intervention effect of an iCBT program on improving nonclinical depressive symptoms between two subgroups classified post-hoc on the basis of time preference among workers in Japan. Methods: All workers in one corporate group (approximate n=20,000) were recruited. Participants who fulfilled the inclusion criteria were randomly allocated to either intervention or control groups. Participants in the intervention group completed 6 weekly lessons and homework assignments within the iCBT program. The Beck Depression Inventory-II (BDI-II) and Kessler's Psychological Distress Scale (K6) measures were obtained at baseline and 3-, 6-, and 12-month follow-ups. Two subgroups were defined by the median of time preference score at baseline. Results: Only few (835/20,000, 4.2\%) workers completed the baseline survey. Of the 835 participants, 706 who fulfilled the inclusion criteria were randomly allocated to the intervention or control group. Participants who selected irrational time preference options were excluded (21 and 18 participants in the intervention and control groups, respectively). A three-way interaction (group [intervention/control] {\texttimes} time [baseline/follow-up] {\texttimes} time preference [higher/lower]) effect of iCBT was significant for BDI-II (t1147.42=2.33, P=.02) and K6 (t1254.04=2.51, P=.01) at the 3-month follow-up, with a greater effect of the iCBT in the group with higher time preference. No significant three-way interaction was found at the 6- and 12-month follow-ups. Conclusions: The effects of the iCBT were greater for the group with higher time preference at the shorter follow-up, but it was leveled off later. Workers with higher time preference may change their cognition or behavior more quickly, but these changes may not persist. Trial Registration: UMIN Clinical Trials Registry UMIN000014146; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi? recptno=R000016466 (Archived by WebCite at http://www.webcitation.org/70o2rNk2V) ",
doi="10.2196/10231",
url="http://www.jmir.org/2018/8/e10231/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30097419"
}


@Article{info:doi/10.2196/mental.8955,
author="Bennett, B. Joel
and Neeper, Michael
and Linde, D. Brittany
and Lucas, M. Gale
and Simone, Lindsay",
title="Team Resilience Training in the Workplace: E-Learning Adaptation, Measurement Model, and Two Pilot Studies",
journal="JMIR Ment Health",
year="2018",
month="May",
day="02",
volume="5",
number="2",
pages="e35",
keywords="workplace",
keywords="resilience",
keywords="stress",
keywords="quasi-experimental",
keywords="experimental design",
keywords="online learning",
keywords="early intervention",
keywords="questionnaire design",
keywords="incentives",
keywords="social support",
keywords="psychological theory",
keywords="gender",
abstract="Background: The majority of resilience interventions focus on the individual. Workplace resilience is a growing field of research. Given the ever-increasing interconnectedness in businesses, teamwork is a guarantee. There is also growing recognition that resilience functions at the team level. Objective: The objective of our work was to address three shortcomings in the study of workplace resilience interventions: lack of interventions focusing on group-level or team resilience, the need for brief interventions, and the need for more theoretical precision in intervention studies. Methods: The authors took an established evidence-based program (Team Resilience) and modified it based on these needs. A working model for brief intervention evaluation distinguishes outcomes that are proximal (perceptions that the program improved resilience) and distal (dispositional resilience). A total of 7 hypotheses tested the model and program efficacy. Results: Two samples (n=118 and n=181) of engineering firms received the Web-based training and provided immediate reactions in a posttest-only design. The second sample also included a control condition (n=201). The findings support the model and program efficacy. For example, workplace resilience was greater in the intervention group than in the control group. Other findings suggest social dissemination effects, equal outcomes for employees at different stress levels, and greater benefit for females. Conclusions: This preliminary research provides evidence for the capabilities of e-learning modules to effectively promote workplace resilience and a working model of team resilience. ",
doi="10.2196/mental.8955",
url="http://mental.jmir.org/2018/2/e35/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29720362"
}


@Article{info:doi/10.2196/mental.8999,
author="Peters, Dorian
and Deady, Mark
and Glozier, Nick
and Harvey, Samuel
and Calvo, A. Rafael",
title="Worker Preferences for a Mental Health App Within Male-Dominated Industries: Participatory Study",
journal="JMIR Ment Health",
year="2018",
month="Apr",
day="25",
volume="5",
number="2",
pages="e30",
keywords="mental health",
keywords="mhealth",
keywords="mobile apps",
keywords="workplace",
keywords="men",
keywords="participatory design",
abstract="Background: Men are less likely to seek help for mental health problems, possibly because of stigma imposed by cultural masculine norms. These tendencies may be amplified within male-dominated workplaces such as the emergency services or transport industries. Mobile apps present a promising way to provide access to mental health support. However, little is known about the kinds of mental health technologies men would be willing to engage with, and no app can be effective if the intended users do not engage with it. Objective: The goal of this participatory user research study was to explore the perceptions, preferences, and ideas of workers in male-dominated workplaces to define requirements for a mental health app that would be engaging and effective at improving psychological well-being. Methods: Workers from male-dominated workplaces in rural, suburban, and urban locations took part in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for mental health support and the design of an app for mental health. Participants generated a number of artifacts (including draft screen designs and promotional material) designed to reify their perceptions, tacit knowledge, and ideas. Results: A total of 60 workers aged between 26 and 65 years, 92\% (55/60) male, from male-dominated workplaces in rural (16/60, 27\%), suburban (14/60, 23\%), and urban (30/60, 50\%) locations participated in one of the 6 workshops, resulting in 49 unique feature ideas and 81 participant-generated artifacts. Thematic analysis resulted in a set of feature, language, and style preferences, as well as characteristics considered important by participants for a mental health app. The term ``mental health'' was highly stigmatized and disliked by participants. Tools including a mood tracker, self-assessment, and mood-fix tool were highly valued, and app characteristics such as brevity of interactions, minimal on-screen text, and a solutions-oriented approach were considered essential by participants. Some implementation strategies based on these findings are included in the discussion. Conclusions: Future mental health mobile phone apps targeting workers in male-dominated workplaces need to consider language use and preferred features, as well as balance the preferences of users with the demands of evidence-based intervention. In addition to informing the development of mental health apps for workers in male-dominated industries, these findings may also provide insights for mental health technologies, for men in general, and for others in high-stigma environments. ",
doi="10.2196/mental.8999",
url="http://mental.jmir.org/2018/2/e30/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29695371"
}


@Article{info:doi/10.2196/jmir.8819,
author="Senecal, Conor
and Widmer, Jay R.
and Bailey, Kent
and Lerman, O. Lilach
and Lerman, Amir",
title="Usage of a Digital Health Workplace Intervention Based on Socioeconomic Environment and Race: Retrospective Secondary Cross-Sectional Study",
journal="J Med Internet Res",
year="2018",
month="Apr",
day="23",
volume="20",
number="4",
pages="e145",
keywords="race and ethnicity",
keywords="socioeconomic position",
keywords="computers",
keywords="health services research",
keywords="health disparities",
abstract="Background: Digital health tools have been associated with improvement of cardiovascular disease (CVD) risk factors and outcomes; however, the differential use of these technologies among various ethnic and economic classes is not well known. Objective: To identify the effect of socioeconomic environment on usage of a digital health intervention. Methods: A retrospective secondary cross-sectional analysis of a workplace digital health tool use, in association with a change in intermediate markers of CVD, was undertaken over the course of one year in 26,188 participants in a work health program across 81 organizations in 42 American states between 2011 and 2014. Baseline demographic data for participants included age, sex, race, home zip code, weight, height, blood pressure, glucose, lipids, and hemoglobin A1c. Follow-up data was then obtained in 90-day increments for up to one year. Using publicly available data from the American Community Survey, we obtained the median income for each zip code as a marker for socioeconomic status via median household income. Digital health intervention usage was analyzed based on socioeconomic status as well as age, gender, and race. Results: The cohort was found to represent a wide sample of socioeconomic environments from a median income of US \$11,000 to \$171,000. As a whole, doubling of income was associated with 7.6\% increase in log-in frequency. However, there were marked differences between races. Black participants showed a 40.5\% increase and Hispanic participants showed a 57.8\% increase in use with a doubling of income, compared to 3\% for Caucasian participants. Conclusions: The current study demonstrated that socioeconomic data confirms no relevant relationship between socioeconomic environment and digital health intervention usage for Caucasian users. However, a strong relationship is present for black and Hispanic users. Thus, socioeconomic environment plays a prominent role only in minority groups that represent a high-risk group for CVD. This finding identifies a need for digital health apps that are effective in these high-risk groups. ",
doi="10.2196/jmir.8819",
url="http://www.jmir.org/2018/4/e145/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29685862"
}


@Article{info:doi/10.2196/mhealth.6335,
author="de Korte, Marieke Elsbeth
and Wiezer, Noortje
and Janssen, H. Joris
and Vink, Peter
and Kraaij, Wessel",
title="Evaluating an mHealth App for Health and Well-Being at Work: Mixed-Method Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Mar",
day="28",
volume="6",
number="3",
pages="e72",
keywords="mHealth",
keywords="work",
keywords="qualitative research methods",
keywords="interview",
keywords="focus group",
keywords="technology acceptance",
keywords="user satisfaction",
keywords="usability",
keywords="well-being",
keywords="prevention",
abstract="Background: To improve workers' health and well-being, workplace interventions have been developed, but utilization and reach are unsatisfactory, and effects are small. In recent years, new approaches such as mobile health (mHealth) apps are being developed, but the evidence base is poor. Research is needed to examine its potential and to assess when, where, and for whom mHealth is efficacious in the occupational setting. To develop interventions for workers that actually will be adopted, insight into user satisfaction and technology acceptance is necessary. For this purpose, various qualitative evaluation methods are available. Objective: The objectives of this study were to gain insight into (1) the opinions and experiences of employees and experts on drivers and barriers using an mHealth app in the working context and (2) the added value of three different qualitative methods that are available to evaluate mHealth apps in a working context: interviews with employees, focus groups with employees, and a focus group with experts. Methods: Employees of a high-tech company and experts were asked to use an mHealth app for at least 3 weeks before participating in a qualitative evaluation. Twenty-two employees participated in interviews, 15 employees participated in three focus groups, and 6 experts participated in one focus group. Two researchers independently coded, categorized, and analyzed all quotes yielded from these evaluation methods with a codebook using constructs from user satisfaction and technology acceptance theories. Results: Interviewing employees yielded 785 quotes, focus groups with employees yielded 266 quotes, and the focus group with experts yielded 132 quotes. Overall, participants muted enthusiasm about the app. Combined results from the three evaluation methods showed drivers and barriers for technology, user characteristics, context, privacy, and autonomy. A comparison between the three qualitative methods showed that issues revealed by experts only slightly overlapped with those expressed by employees. In addition, it was seen that the type of evaluation yielded different results. Conclusions: Findings from this study provide the following recommendations for organizations that are planning to provide mHealth apps to their workers and for developers of mHealth apps: (1) system performance influences adoption and adherence, (2) relevancy and benefits of the mHealth app should be clear to the user and should address users' characteristics, (3) app should take into account the work context, and (4) employees should be alerted to their right to privacy and use of personal data. Furthermore, a qualitative evaluation of mHealth apps in a work setting might benefit from combining more than one method. Factors to consider when selecting a qualitative research method are the design, development stage, and implementation of the app; the working context in which it is being used; employees' mental models; practicability; resources; and skills required of experts and users. ",
doi="10.2196/mhealth.6335",
url="http://mhealth.jmir.org/2018/3/e72/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29592846"
}


@Article{info:doi/10.2196/ijmr.9001,
author="Brakenridge, L. Charlotte
and Healy, N. Genevieve
and Winkler, AH Elisabeth
and Fjeldsoe, S. Brianna",
title="Usage, Acceptability, and Effectiveness of an Activity Tracker in a Randomized Trial of a Workplace Sitting Intervention: Mixed-Methods Evaluation",
journal="Interact J Med Res",
year="2018",
month="Mar",
day="02",
volume="7",
number="1",
pages="e5",
keywords="wearable electronic devices",
keywords="fitness trackers",
keywords="sedentary lifestyle",
keywords="exercise",
keywords="workplace",
keywords="adult",
abstract="Background: Wearable activity trackers are now a common feature of workplace wellness programs; however, their ability to impact sitting time (the behavior in which most of the desk-based workday is spent) is relatively unknown. This study evaluated the LUMOback, an activity tracker that targets sitting time, as part of a cluster-randomized workplace sitting intervention in desk-based office workers. Objective: Study objectives were to explore: (1) office workers' self-directed LUMOback use, (2) individual-level characteristics associated with LUMOback use, (3) the impact of LUMOback use on activity and sitting behaviors, and (4) office workers' perceived LUMOback acceptability. Methods: Exploratory analyses were conducted within the activity tracker intervention group (n=66) of a 2-arm cluster-randomized trial (n=153) with follow-up at 3 and 12 months. The intervention, delivered from within the workplace, consisted of organizational support strategies (eg, manager support, emails) to stand up, sit less, and move more, plus the provision of a LUMOback activity tracker. The LUMOback, worn belted around the waist, provides real-time sitting feedback through a mobile app. LUMOback usage data (n=62), Web-based questionnaires (n=33), activPAL-assessed sitting, prolonged (?30 min bouts) and nonprolonged (<30 min bouts) sitting, standing and stepping time (7-day, 24 h/day protocol; n=40), and telephone interviews (n=27) were used to evaluate study aims. LUMOback usage data were downloaded and described. Associations between user characteristics and LUMOback usage (in the first 3 months) were analyzed using zero-inflated negative binomial models. Associations between LUMOback usage and 3-month activity outcomes were analyzed using mixed models, correcting for cluster. LUMOback acceptability was explored using 3-month questionnaire data and thematic analysis of telephone interviews (conducted 6 to 10 months post intervention commencement). Results: Tracker uptake was modest (43/61, 70\%), and among users, usage over the first 3 months was low (1-48 days, median 8). Usage was greatest among team leaders and those with low self-perceived scores for job control and supervisor relationships. Greater tracker use (?5 days vs <5 days) was significantly associated only with changes in prolonged unbroken sitting (?50.7 min/16 h; 95\% CI ?94.0 to ?7.3; P=.02) during all waking hours, and changes in nonprolonged sitting (+32.5 min/10 h; 95\% CI 5.0 to 59.9; P=.02) during work hours. Participants found the LUMOback easy to use but only somewhat comfortable. Qualitatively, participants valued the real-time app feedback. Nonuptake was attributed to being busy and setup issues. Low usage was attributed to discomfort wearing the LUMOback. Conclusions: The LUMOback---although able to reduce prolonged sitting time---was only used to a limited extent, and its low usage may provide a partial explanation for the limited behavior changes that occurred. Discomfort limited the feasibility of the LUMOback for ongoing use. Such findings yield insight into how to improve upon implementing activity trackers in workplace settings. ",
doi="10.2196/ijmr.9001",
url="http://www.i-jmr.org/2018/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29500158"
}