Co-Design, Delivery, and Evaluation of Wellbeing Initiatives for NHS Staff: The HOW (Healthier Outcomes at Work) NHS Project.

Stress and mental health are leading causes of sickness absence in the UK, responsible for over 50% of sickness absence across the country. Healthcare sector workers play a vital role in the life of everyone across the country but have among the highest levels of sickness absence of any sector. The aim of this project, therefore, was to work with UK healthcare workers to co-develop, implement, and evaluate a series of mental health and wellbeing interventions delivered via a smartphone app and associated toolkit. A participatory action research methodology, consisting of individual interviews, focus group discussions, and oversight by an expert action learning group, was used to develop primary (i.e., those associated with the workplace) and secondary (improving individual resilience and coping) stress management interventions. Pre-post-intervention analysis demonstrated improvements in work engagement and working conditions, although significant improvements were only found in mean scoring on demands, control, managerial support, and peer support working condition measures. The project therefore demonstrates that co-produced initiatives which focus on improving either the organisation or resilience of the workforce may be useful in supporting employee health and wellbeing. Future studies should build upon these findings through a full RCT to determine utility of the interventions.

Co-Creating and Evaluating an App-Based Well-Being Intervention: The HOW (Healthier Outcomes at Work) Social Work Project.

Stress and mental health at work are the leading causes of long-term sickness absence in the UK, with chronically poor working conditions impacting employee physiological and psychological health. Social workers play a significant part in the fabric of UK society, but have one of the most stressful occupations in the country. The aim of this project was to work with UK social workers to co-develop, implement, and evaluate a series of smartphone-based mental health initiatives. A Participatory Action Research (PAR) approach, consisting of semi-structured interviews and focus group and steering group discussions, was utilized to design the mental health and well-being interventions. Study efficacy was evaluated via a pre- and post-intervention survey and post-intervention semi-structured interviews. Interventions developed were psycho-educational, improved top-down and bottom-up communication, and provided access to a Vocational Rehabilitation Assistant for those struggling and at risk of sickness absence. Six months following dissemination, surveys demonstrated significant improvements in communication, and mean score improvements in four other working conditions. This project, therefore, demonstrates that co-developed initiatives can be positively impactful, despite post-intervention data collection being impacted by COVID-19. Future studies should build upon these findings and broaden the PAR approach nationally while taking a robust approach to evaluation.

Work Stress in NHS Employees: A Mixed-Methods Study.

The United Kingdom's National Health Service (NHS) has a higher-than-average level of stress-related sickness absence of all job sectors in the country. It is important that this is addressed as work stress is damaging to employees and the organisation, and subsequently impacts patient care. The aim of this study was to gain an in-depth understanding of working conditions and wellbeing in NHS employees from three employing NHS Trusts through a mixed-methods investigation. First, a cross-sectional organisational survey was completed by 1644 respondents. Questions examined working conditions, stress, psychological wellbeing, job satisfaction, and presenteeism. This was followed by 33 individual semistructured interviews with NHS staff from a variety of clinical and nonclinical roles. Quantitative findings revealed that working conditions were generally positive, although most staff groups had high levels of workload. Regression outcomes demonstrated that a number of working conditions influenced mental wellbeing and stress. Three themes were generated from thematic analysis of the interview data: wellbeing at work, relationships, and communication. These highlight areas which may be contributing to workplace stress. Suggestions are made for practical changes which could improve areas of difficulty. Such changes could improve staff wellbeing and job satisfaction and reduce sickness absence.

Biology of stress revisited: intracellular mechanisms and the conceptualization of stress.

Application of allostatic theory to stress during the 1990s refocused attention on internal responses to a perceived hazard, and the last 20 years has seen considerable developments in the biological contexts of stress. Evidence from neuroscience now suggests that secretion of the hormone cortisol is not only stimulated by the outcomes of cognitive transaction but it also feeds back and contributes positively to the cognitive adaptation that is a feature of stress resilience. More recently, the operative intracellular mechanisms are beginning to be understood and provide an insight into the regulation and maintenance of intracellular homeostasis that underpins adaptive change and vulnerability. The maintenance or appropriate modulation of intracellular homeostasis usually provides a buffering of potential adverse interactions. However, the capacity to do so is diminished during chronic stress leading to intracellular and subsequently systemic, homeostatic failure and hence maladaptation. This area of research seems far removed from cognitive theory, but placing intracellular homeostasis at the core of cognitive and biological responses supports the concept of stress as a genuinely psycho-biological phenomenon.